Local Suicide Prevention Plans

Norman Lamb Excerpts

Wednesday 4th March 2015 Westminster Hall

[The Minister of State, Department of Health (Norman Lamb)]

It is a pleasure to serve under your chairmanship, Mr Gray, I think for the first time. I congratulate the hon. Member for Bridgend (Mrs Moon) on securing the debate and, more importantly, on her leadership on the subject of suicide prevention. Nothing could be more important, and any conversation with those going through bereavement following the death of a loved one through suicide makes us realise just how important it is for us to do better. The impact on those people’s lives is massive—the reverberations that she talked about are enormous. We can talk about the cold economic facts and the cost of £1 million per suicide, but the reverberations and economic impact on the whole family and beyond are incalculable.

The hon. Lady also made a point about the suicide rate varying so much around the country, and said that in some areas it appears to be remarkably low. One of the issues that she and I have talked about is whether suicides are being accurately recorded in inquests. We have a completely shared view on the need, once and for all, to confront the issue of the burden of proof, which is an example of the continuing stigma on suicide. To secure a suicide verdict, it remains necessary to prove the suicide “beyond reasonable doubt”; the only other type of death in which that level of proof applies is unlawful killing. That harks back to when suicide was a criminal offence. It is high time that was changed. I have argued the case in government and will continue to do so—whether in or out of government—in the next Parliament, because the change has to happen.

I congratulate the all-party group on suicide and self-harm prevention on its work, and from the start I want to pick up on the role of the police. In my work on mental health, I have been impressed by some inspiring leadership in police forces across the country. In London, the Metropolitan police have worked brilliantly with mental health trusts. In many areas, police are taking the lead in ending the scandal of people being put into police cells in the middle of a mental health crisis. I applaud them.

[Mrs Moon]

The British Transport police have undertaken some particularly successful work in conjunction with the Samaritans on preventing deaths on the railway. That, too, should be recognised.

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[Norman Lamb]

I agree. Every person lost to suicide is a tragedy, for loved ones, the community and society as a whole. I was deeply concerned to read the latest figures from the Office for National Statistics, which showed a rise in the suicide rate. Back in 2012, when I launched the suicide prevention strategy for England, we knew that we could not afford to be complacent about suicide, and much remains to be done. The new challenges are now clear, and in the second annual report for the strategy, I called on services, communities and national agencies to be more ambitious than ever before with regard to suicide prevention.

Collectively, I want us to tackle the widespread assumption that suicides are inevitable for a certain proportion of people. That is absolutely not the case. I have had discussions with Professor Louis Appleby, who is the foremost thinker and academic on suicide, and he said that in his 25 years of experience he had never looked at the details of a suicide without seeing ways in which the death might have been prevented. That encapsulates the challenge for public services and, beyond, for society as a whole. Suicide is not inevitable for any individual. We need to get that point across.

In 2014, important steps were taken. In January of that year, we published the consensus statement on information sharing and suicide prevention, signed by the Royal College of Psychiatrists, the Royal College of General Practitioners, the Royal College of Nursing, the British Psychological Society, the British Association of Social Workers, the College of Social Work, the Mental Health Network of the NHS Confederation and the Association of Directors of Adult Social Services. The statement aims to improve information and support for families—that is critical—who are concerned about a relative who may be at risk of suicide, and to support better those who have been bereaved as a result of suicide.

In January 2014, we also published “Closing the Gap: priorities for essential change in mental health”, which sets out 25 changes that we believe it is absolutely necessary for the NHS and the care system to make in the next few years to improve the lives of people suffering from mental ill health, and to reduce health inequalities. It highlights how we will change the way front-line health services respond to self-harm, an issue that the hon. Lady has pursued vigorously, and how we improve crisis care in mental health.

At the start of 2014, the National Suicide Prevention Alliance was launched, facilitated by Samaritans and supported by Department of Health grant funding of £120,000 over 2013-14 and 2014-15. In July, the Department awarded a grant of £556,000 over three years to a partnership between Samaritans and Cruse, the bereavement counselling organisation, to increase support for those bereaved by suicide. Samaritans and Cruse will offer that support, working with organisations locally.

I know, however, that we can still save far more lives. It is a moral imperative that we take this issue seriously. As the hon. Lady will be aware from our previous discussions, I share her concerns about better suicide prevention. There have been a number of recent worrying trends in suicide rates, such as the rise of new suicide methods, such as using helium. The Government are committed to improving mental health services as a whole and reducing the suicide rate.

As the hon. Lady will be aware, the Deputy Prime Minister also shares my concerns, which is why in January he announced our ambition for zero suicides. That ambition has already been adopted in some areas. I pay tribute to the brilliant leaders, including Adrian James, a psychiatrist in Devon, and Joe Rafferty, the chief executive of Mersey Care, who have got organisations in their areas to adopt the ambition and start developing plans to achieve a dramatic reduction in suicide, aiming for zero suicide. That is of course what we should aim for, but it cannot be dictated from Whitehall. It requires real leaders to grasp the opportunity and to be ambitious.

Together we need to create a culture in our country in which everyone can talk about their mental health problems without fear or embarrassment. For that ambition to be fulfilled, it is essential that every part of the NHS commits to it. As I have mentioned, pioneering work in Merseyside, the south-west and the east of England means that health workers are starting to rethink how they care for people with mental health conditions. The Deputy Prime Minister called on the health service to look at the work being done by those three pioneering areas. Adopting those kinds of approaches across the country, with serious commitment, could save thousands of lives. We need to raise our aspirations for mental health, although we need to be clear that zero suicide is not a target but an ambition for organisations to aspire to. Nor is it about blame—that would be unhelpful for staff, for people using services and for communities and families. It is about constant learning—Louis Appleby has described so many examples from over the course of his career—and, critically, applying that learning to improve the system.

We know that many who take their own lives are not in touch with mental health services, a point that the hon. Lady frequently makes. That is why we need to apply the same ambition to primary care services and the wider community. The zero suicide initiative had its origins in Detroit, where a programme has successfully reduced the rate of suicides in in-patient care, with not a single suicide for a period of over two years. Although the study on the claim has not been peer-reviewed, the programme also claims to have reduced the suicide rate across the wider general population—that is the really exciting thing. That is why we need to be willing to learn constantly. We need to work together to challenge the stigma attached to mental ill health and change the way society as a whole thinks about it, starting in local communities.

I read with interest January’s report by the all-party group on suicide and self-harm. I know that the inquiry into local suicide plans concluded that there are significant gaps in the local implementation of the national suicide prevention strategy. I agree that that is a concern. As I have said in writing to the hon. Lady, I am confident that the APPG report will be of great value at local, regional and national levels. We know that it is at the local level that the most effective suicide prevention activity will take place. I am happy to write to those local authorities that have nothing in place, and to copy her into that correspondence.

Both the Department of Health and Public Health England agree that even the areas with comparatively low levels of suicide should aspire to do better. That is why we have challenged services, communities and national agencies to adopt the zero suicide ambition. I also agree with the APPG report that timely and reliable data are a valuable suicide prevention tool. Public Health England is working with police forces and local support agencies to pilot real-time surveillance of local suicides. The primary aim of the pilots is to provide prompt information to front-line local authority and NHS staff to enable them to respond to potential and real local clusters of suicides, and to provide timely support to people bereaved by suicide. Public Health England’s evaluation of the surveillance pilots will identify challenges to data collection at a local level and identify best practice to overcome them. The evaluation of the pilots will be available by the summer.

The national mental health intelligence network is developing a new profiling tool on suicide for release shortly, which will make available suicide rates and trends for the main age and gender groups at both local authority and clinical commissioning group level, so that there can be much more accountability. The tool will provide data on high-risk groups that can be used to inform priorities for local interventions.

I was pleased to see that the APPG welcomed Public Health England’s guidance for developing local suicide prevention action plans. The guidance will be updated later in the year and will incorporate best practice on data collection from the surveillance pilots. The hon. Lady will be aware that the guidance was published after the all-party group’s audit took place; Public Health England will contact all its centres over the coming months to discuss activity in their areas and track progress. Public Health England will publish further support for local authorities on identifying and responding to clusters and frequently used locations for suicides, and will also support local systems in developing and undertaking effective local suicide audits, a point that she raised.

We are also working with the National Suicide Prevention Alliance to help ensure that information is pulled together on its new website, which has been supported by grant funding from my Department. We know that sharing local case studies is important, which is why we included a number in the second annual report in the suicide prevention strategy.

The annual report was written for people working in local services, to pull together the key information that they need to implement the strategy locally. The second report on the strategy highlights the excellent work being done across sectors to prevent suicides, and sets out where efforts need to be concentrated for the next year. Local action, supported by national co-ordination, is essential to suicide prevention. The messages in the report are designed to help local areas focus on the most effective things that can be done to reduce suicides. The report also highlights the APPG’s findings and encourages local areas to use the detailed information from the inquiry in drafting their local suicide plans.

All our work on suicide prevention is part of our wider commitment to give mental health services parity of esteem and equality with physical health services. Investment and achievements in bettering mental health services inevitably have a positive impact on suicide prevention. If we make crisis response in mental health much better, so that people know how to get help at the moment when they need it, that will do so much to help those people get through a moment of crisis. I thank the hon. Lady for pursing this issue so vigorously.

Child and Adolescent Mental Health Services

Norman Lamb Excerpts

Tuesday 3rd March 2015 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

It is a pleasure to open this debate on our report into child and adolescent mental health services. For the record, I am married to a full-time NHS adult forensic psychiatrist who is also the chair of the Westminster Parliamentary Liaison Committee for the Royal College of Psychiatrists. I thank the many organisations and individuals who have contributed to our report, my fellow Committee members and the Clerk of our Committee, David Lloyd for his exemplary leadership and work over the course this Parliament.

May I start by setting the scene? This report was launched in part because of the number of children and young people who were being admitted to hospitals many hundreds of miles from home when they were in mental health crisis and needing the highest level of support.

During the course of our inquiry, we identified serious and deeply ingrained problems with the commissioning and provision of child and adolescent mental health services, and we found that they ran throughout the whole system from prevention and early intervention services to in-patient services for the most vulnerable children and young people.

We welcomed the setting up by the Government of the Children and Young People’s Mental Health and Wellbeing Taskforce, and many of our recommendations were directed at that taskforce. I am sorry that it has not yet reported, but I understand that it is to report very shortly, and we look forward to seeing its recommendations. The taskforce knows that it is a matter not just of tweaking the CAMHS system but of fundamental change. I hope that it will clearly set out how that will be implemented. We have legislated for parity of esteem, we have written it into the NHS Mandate, but all that counts for nothing if it does not translate into better services for children and young people.

The key recommendation in our report is about the importance of prevention and early intervention. However, services cannot be planned without knowing the extent of the problem. It is a matter of great regret that the five-yearly prevalence survey was cancelled under the previous Government. That means that our data are 10 years out of date. I very much welcome the reinstatement of that survey. In his response, will the Minister give further details of the extent? I know that he has already announced that the funding has been identified, but many professionals are waiting to hear further detail about exactly what will be included. That would be very welcome.

While we wait for the prevalence data to appear—it would be nice to hear the expected time frame in which we will hear the results—we all acknowledge that there has been an alarming rise in the level of distress and need reported by all those who work in the field, including those in the voluntary sector, in teaching and in CAMHS. There are unprecedented levels of demand at a time when, unfortunately, 60% of local authorities that responded to a survey from YoungMinds report cuts or a freeze in their CAMHS budget. That is where the front line of prevention should be.

The compelling evidence that we heard throughout our report was that early intervention prevents children from presenting when they have become more unwell, so that is where we need to focus our resources. Clearly, the Government were right and everybody welcomes the investment in 50 extra beds in the areas of greatest need—some of which are in my area—but it costs around £25,000 a month for a child or young person to be treated in an in-patient setting. For every young person who is in one of those beds, we have to ask whether they would have needed to be admitted to hospital in the first place had those resources been properly directed to prevention services. We need double running. If we just keep investing in in-patient beds at the expense of prevention, we will fill those beds and there will be a demand for more.

I hope the Minister will recognise the need for double running so that we focus relentlessly on prevention and early intervention. As he will know, if we are looking at in-patients and admissions, the very last place that any young person should be at a time of mental health crisis is in a police cell. I pay tribute to all those who, over a number of years, have campaigned on that. The problem is not new. I am one of the few MPs—or perhaps not so few—who has been inside a police cell at night, because for many years I was a forensic medical examiner. It was always profoundly shocking to think that children as young as 12 or 13 across the west country were being taken into police cells under section 136 of the Mental Health Act 1983—an horrific experience.

It is sometimes an individual case that finally brings an unacceptable practice to an end. I pay tribute to Assistant Chief Constable Paul Netherton of Devon and Cornwall police for highlighting the awful case in Torbay of a child who was detained in a police cell, and I pay tribute to Chief Constable Shaun Sawyer because they have taken steps to bring the practice to an end. Although as a Committee we called for this to be a “never event” within the NHS, in effect the procedures that will be put in place will be equivalent. Finally, on this Government’s watch, we will see this unacceptable practice coming to an end. That is long overdue and very welcome.

In focusing on the need to keep that timely support for children and young people, I also hope that the taskforce will set out what can be done to address some of the perverse financial incentives in children and young people’s mental health services. For example, a child who is admitted to hospital no longer has to be funded by the clinical commissioning group—in other words, they are handed over to specialist commissioning— creating all sorts of inappropriate decision making in the system. It also means that children are more likely to be readmitted because there are no step-down services. Therefore, a focus on active intervention to try to prevent that admission and keep children at home is very important. I also look forward to hearing the taskforce’s recommendations on how that can be done consistently across the country, because another issue we raised was the extent of variation in practice.

I will now turn my attention to volunteers. If we are to retain a focus on the earliest intervention and prevention, we have to recognise the value of our volunteers. I would like to pay tribute to a number of volunteers in my constituency. I am a patron of Cool Recovery, a charity that provides mental health support to carers and those affected by mental health problems across south Devon. There are many such organisations working directly with young people. Representatives from Spiritulized, which supports young people in Kingsbridge, recently came to Parliament after being shortlisted for an award for the work it is doing in mental health first aid out in the community. In Brixham there is the Youth Genesis Trust and volunteers from The Edge. Work is also being done in schools. Representatives from South Devon college, which is based in my constituency, recently came to Parliament after it received an award for its work in student well-being and prevention of mental health problems.

Those organisations are reporting that both the demand for their services and the level of complexity have never been greater. Part of the reason for that, as the Minister will know, is the increasing waiting times for CAMHS. That means more young people are becoming much more unwell before being seen in the CAMHS setting. I hope that in his response he will be able to say exactly how we can balance that across the whole system. I very much welcome the investment in services for eating disorders and self-harm and early interventions in psychosis, and of course the Improving Access to Psychological Therapies programme. However, as he will know, fundamentally the issue comes down to funding. We will never achieve parity of esteem for mental health unless we address the funding inequality, with 6% of the mental health budget going to services for children and young people, and that budget itself is an inappropriately small slice of the overall funding pot for the NHS. How will we actually drive change in increasing funding?

[The Minister of State, Department of Health (Norman Lamb)]

I agree with everything my hon. Friend has said and very much welcome her Committee’s report. I agree on the need to address the funding issue. In particular, it is critical that we achieve what I call an equilibrium of rights to access between mental and physical health in order to address the awful problem on waiting times, and that must include children’s mental health services.

[Dr Wollaston]

I thank the Minister for that intervention. It is very welcome that we now have waiting time targets as a right for people with mental health problems, alongside those for people with physical health problems, but the challenge is not so much about the budget for children and young people’s mental health services, but what we take that from, because there are no areas of slack in the mental health budget, as he will know. I think that the mental health budget overall must achieve some parity. Again, if we look at prevention and the really small amounts of money, in relative terms, that are required to keep excellent voluntary services running in our communities, we see that it would be the greatest waste and tragedy to lose those vital services in our communities for the want of what are really quite small sums. When children, young people and voluntary services came to give evidence to our inquiry, we heard time and again that what they need is stable, long-term funding. They do not require a great deal of money, but they are currently limping from one short-term budget to another. Another issue raised was that if funding is available, it often gets directed to a new start-up project, not towards a project in the same community that may have proven value.

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[Paul Blomfield]

I thank my hon. Friend for making that powerful point. The situation in Stoke, Sheffield and Coventry underlines his point that there used to be a hinterland beyond the NHS of youth groups, activities and support networks, many of which were supported by local government funding in combination with funding that was often raised within communities. The withdrawal of that funding, as local authorities have increasingly had to focus on statutory services, has put many of those groups at a tipping point and left the support that is available very weak.

The third point that young people have made to me is about being abandoned at 16. Historically, CAMHS in Sheffield have worked with people up to the age of 16, leaving those beyond that age—before they turn 18 and become part of adult provision—to fall through a hole. Things looked a bit brighter for 16 and 17-year-olds when the clinical commissioning group committed just £300,000 a year to a service for them, although I am not sure why it did not include 18-year-olds as well. However, budgets are squeezed and it has since been announced that the funding will be cut by a third. That is another example of the budget pressures being experienced and it is happening within the NHS as opposed to local authorities, which we have discussed.

In effect, £200,000 allows the service to work with little more than 100 young people aged 16 to 17 in a given year. On funding relative to need, there are 12,627 young people aged 16 to 17 living in Sheffield and it is estimated that 10% of them have some sort of mental health challenge. That leaves more than 90% of those we could expect to need support with no service at all. We cannot keep talking about reducing stigma, eradicating stereotypes and parity of esteem between physical and mental health without funding services properly when people—especially young people—need that help. We have serious questions to answer on the challenges posed to us by the issues raised with me by young people in Sheffield and those raised by the Youth Parliament.

We know that, nationally, mental health problems account for 28% of morbidity, but only 13% of expenditure is committed to mental health. Where is the parity in that? I hope the Minister will address that when he responds to the debate. We need to put our money where our mouth is. I am pleased that Labour has committed to increasing the proportion of mental health spend on CAMHS, which is currently a tiny amount of 6% even though three quarters of adult mental illness begins before the age of 18.

[Norman Lamb]

I agree with the hon. Gentleman about the need to increase resource in children’s mental health services. Is the proposal he mentions designed to increase investment in mental health or to shift resource from adult mental health to children’s mental health?

[Paul Blomfield]

I am sure my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) on the Front Bench will come back to this issue. My understanding is that our proposal is both to increase the overall resource available in the NHS and to shift resource within the service towards supporting CAMHS.

We will also train NHS staff and teachers to spot problems sooner. We will expand talking therapies and work towards a 28-day waiting time standard for access to both adult and young people’s talking therapies. That is crucial, given what I have heard from young people. Moreover, as I said a moment ago, we will invest an additional £2.5 billion in the NHS to fund extra nurses, doctors and other health workers, to relieve pressure on the service. We owe it to our young people to respond to their calls and I am pleased to have had the opportunity to articulate some of their concerns.

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[The Minister of State, Department of Health (Norman Lamb)]

The debate has been undertaken in a rational way—we have not had the hurling of abuse from one side to the other. My hon. Friend the Member for Windsor (Adam Afriyie) said that the report is objective and that it analyses problems and seeks to come up with solutions. The debate has been conducted in that way, which I welcome.

I am grateful to the Health Committee for its work, and for the inspired leadership of my hon. Friend the Member for Totnes (Dr Wollaston), who speaks with great authority on the subject. She is a force for good in this place. I thank her for her leadership.

My hon. Friend said that the report was triggered by the awful practice of youngsters being shunted around the country in the middle of a crisis. The situation with adults is just as bad. That practice should not happen other than where there is a specialist need and a specialist service that cannot, with the best will in the world, be provided in every locality. We have sought to analyse the causes of out-of-area placements. We see enormous variation around the country. Many areas do not do it, but where it does happen, we believe that simple steps could be taken to stop it. In my view, they must be taken.

[Roger Williams (Brecon and Radnorshire) (LD)]

The Minister will be aware from his visit to my constituency that young people from Wales are being treated in Kent and Northampton. Does he agree that that will do nothing to provide decent service, care and treatment for them?

[Norman Lamb]

I agree. It is intolerable. One can only imagine the impact on the family having to travel such long distances. My hon. Friend and I had that discussion in Brecon with the family concerned. It is shocking that that practice continues. It must be a priority.

My hon. Friend the Member for Totnes said that the importance of early intervention is a central theme of the report. There is great scope for much more to be done on public mental health. It was revealed recently that a tiny proportion of public health budgets in localities is spent on public mental health, and yet we know—there is loads of evidence—that, if we invest in public mental health, we can achieve a significant return on it. I welcome the report.

The hon. Member for Sheffield Central (Paul Blomfield) talked about what young people had told him. It was great that they were given a voice directly in this place. I welcome his comments.

In a very thoughtful speech, as always, my hon. Friend the Member for Southport (John Pugh) talked about a continuum. Many of us are susceptible to poor mental health in certain circumstances. That makes the point about the importance of schools, which other hon. Members mentioned, in building resilience and keeping youngsters stronger so that they can cope with all the challenges they inevitably face these days.

The hon. Member for Stoke-on-Trent South (Robert Flello) talked about Malachi, an organisation he was involved with, and about the triggers that can cause mental ill health among youngsters. Family breakdown is one, but bereavement can have a significant impact, as can bullying at school, which another hon. Member mentioned.

[Robert Flello]

Will the Minister give way?

[Norman Lamb]

I am conscious that I need to get through quite a lot in the time available to me.

I thank my hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) for his kind comments. He was absolutely right about the potential for online access. The hon. Member for Windsor made a similar point. There is enormous potential. One platform is called Kooth. Good evidence is developing about the impact that online access can have. Given that so many youngsters with poor mental health get no support at all, we can do a lot to increase access, not as a replacement for other services, but as a complement. He, too, talked about the importance of the role of schools.

I worked in Parliament as a junior researcher in 1980, for a Labour MP. I shared an office with the secretary of the hon. Member for Coventry North West (Mr Robinson). He is still here 35 years later. He is clearly the great survivor. He referred to the most appalling wait of 44 weeks in Coventry, which is totally unacceptable. I do not know what is going wrong in that locality, but that is not matched in many other places. There may be particular problems that need to be faced. In a way, that makes the case I have been making throughout my time as Minister that the same access and waiting time standards for physical health should exist for mental health. That is the big discrimination against mental health, and it has existed for a very long time.

[Ian Mearns (Gateshead) (Lab)]

Waiting times are so much more crucial for children and young people with mental health issues.

[Norman Lamb]

I totally agree. When I embarked on the mission to introduce waiting time standards in mental health, I was very clear throughout that they must apply equally in children’s services, as in any other service. One of the first two standards we are introducing from April this year is a two-week standard to start treatment for early intervention in psychosis, where there is a wealth of evidence that quick intervention can lead to good results.

My hon. Friend the Member for Brigg and Goole (Andrew Percy) talked about the absolute importance of youngsters learning about mental health at school. It ought to be part of the curriculum, and we would benefit a lot if that was the case. He also made the important point that although lots of areas of the country have seen really ridiculous disinvestment in mental health and children’s mental health, other enlightened areas have not done that. There is no necessity for it to happen; it depends on what the local priorities are. In his area they have done the right thing and made the necessary investment.

The hon. Member for Easington (Grahame M. Morris) talked about the horror of suicide. The husband of my hon. Friend the Member for Totnes is a psychiatrist in Devon. He has been a brilliant advocate of the case for a zero-suicide ambition. Every organisation within the NHS ought to be setting the same ambition that has been set in Devon.

The Government have prioritised improving mental health as part of our commitment to achieving parity of esteem, or, as I would prefer to call it, equality. I have been frank that the current system for supporting children and young people’s mental health is simply not good enough, but let us be clear that this is not a new problem. Previous reviews into CAMHS have identified similar issues to those that the Committee highlights, such as a lack of beds, complex commissioning and referral arrangements, poor practice around transition from children to adult services, and instances of children being treated far from home or on adult wards. These issues are deep-seated and hard to resolve. Lord Crisp was recently quoted in the Health Service Journal, when asked about parity of esteem:

“If something has developed over 40 or 50 years you don’t solve it in five minutes.”

I know a youngster who in the past decade was horribly let down by mental health services at that time. This is not something that has just emerged over the course of this Parliament. I fully recognise that too many areas of the country have disinvested in young people’s mental health. I firmly believe that the situation can and must improve. The Government have taken steps to do this.

It is worth saying that, as I have done this job, I have seen some really impressive services. There is a brilliant NHS team in Accrington providing the best possible service to young people. I visited South London and Maudsley, where there is a fantastic eating disorder service based on the quickest intervention, with specialist support for youngsters very quickly reducing massively in-patient admissions. That is the sort of service we need to see across the country. There is a brilliant in-patient facility in Colchester, where there is a great school in the mental health service so that youngsters do not lose out on their education while they are receiving support. There are some brilliant third sector organisations. MAC-UK is a wonderful organisation that takes therapy out on to the streets to support youngsters who get involved in gangs, rather than expecting youngsters in those circumstances to visit traditional services. MAP—the Mancroft Advice Project—in Norwich is a brilliant service supporting youngsters in a non-stigmatising way.

Since 2010, we have raised the profile of children and young people’s mental health to unprecedented levels. We have produced the mental health and suicide prevention strategies, set out the top 25 priorities to help to achieve parity of esteem in the “Closing the gap” document last year, and we have worked, through Time to Change, to reduce the stigma attached to mental health issues. The 2014-15 mandate to NHS England sets it a clear objective to deliver equality and parity of esteem, and in 2014 we published our five-year vision for mental health. At its heart was a radical change: an ambition to set access and waiting time standards for mental health—just as they exist for physical health—including children and young people’s mental health, for all services by 2020. That is a landmark step in rebalancing our health and care system and achieving equality.

[Mr Robinson]

It is good to hear that the Government are setting those targets. Will the Minister have a look at the situation in Coventry and explain to me why it has happened? Can he also confirm that the targets he has set will be achievable, despite the £50 million cut that has been made?

[Norman Lamb]

I am very happy to look at Coventry if the hon. Gentleman wants to send me a note about that.

I make the case that there needs to be more investment in mental health, and my party has argued for £500 million of additional investment a year in mental health in the next Parliament. Investing £54 million for the children and young people’s IAPT—improving access to psychological therapies—programme has started to transform existing services, and it now covers 68% of the nought to 19-year-old population, which exceeds the original target of 60% by 2015. NHS England continues to plan for nationwide roll-out, as set out in the mandate, which should be achieved by 2018.

As part of the autumn statement, the Deputy Prime Minister and I announced £150 million of investment over the next five years to deal with eating disorders. This will help to ensure that any young person can get the help they need, no matter where they live, and will allow the development of waiting time standards for eating disorders from 2016. This is a condition that can kill, so it is so important that we get early access. We have invested £3 million in MindEd, a digital resource to help people who work with young people and children. It is an online platform designed to give them the help that they need in the work that they do.

The prevalence survey is being undertaken—we have secured the money for it—and we plan for it to be ready by 2017. The aim is for it to cover children and young people from two years to 19 years, which is a wider range than in the original survey. That should be widely welcomed.

As for the taskforce, although there has been much progress, the Government have been open about the scale of the challenge and acknowledged that there is still much to do. As the Committee is aware, I set up the taskforce last summer. It is chaired jointly by the Department and NHS England and brings together a whole load of experts from outside Whitehall and listens to the voice of young people as well. This is a massive opportunity fundamentally to modernise the way children and young people’s health services operate, embracing the role of the voluntary sector and the potential for online support for youngsters, and sorting out this ridiculous, fragmented commissioning. The problem has been there for a long time, but things need to be made much simpler, so that we can have coherent services that are easily understandable for children and their families. If we can grasp this opportunity, we can make a massive difference for young people.

Let me say a word about crisis care. In a way, this is the area where the gap between physical and mental health is greatest. The Torbay case that my hon. Friend the Member for Totnes mentioned was a shock to the system, although we have already seen considerable reductions in the number of young people going into police stations. We are on course to see a reduction of about 30% this year, but it needs to be much greater than that. In my view, we need to legislate to end the practice completely. It is surely completely unacceptable that young people under the age of 18 end up in police cells rather than in a hospital. That practice simply has to come to an end.

I applaud everyone who has participated in this debate on a really important subject. I think we have an opportunity massively to improve things.

[Mr Speaker]

We thank the Minister, whose sense of timing is almost immaculate. I know that he intended that this debate should finish at seven o’clock, which it has done.

Question deferred (Standing Order No. 54).

End-of-Life Care

Norman Lamb Excerpts

Thursday 26th February 2015 Written Statements

[The Minister of State, Department of Health (Norman Lamb)]

The independently led review of choice in end-of-life care has published its advice to Government today. I commissioned this review in July 2014 to look into how quality and experience for people approaching the end of life can be improved by expanding choice. The review was chaired by Claire Henry MBE, chief executive of the National Council of Palliative Care.

This Government are committed to ensuring that people nearing the end of their lives get high quality, compassionate care which is focused on their individual needs and preferences.

I welcome the review’s advice, which proposes that a “national choice offer” for everyone in need of end-of-life care should be in place by 2020 and sets out the actions needed to deliver this. As the review rightly notes, many people in England already receive good end-of-life care, focused on their choices, and I want to pay tribute to everyone involved in this care, both staff and carers.

The review’s advice has outlined a series of actions to ensure that everyone receives good care at this important point in their lives. This advice covers:

Early identification of people who are approaching the end of life.

Greater use of:

advance care planning to record people’s choices and preferences; and

electronic systems which enable records to be shared among all those involved in the person’s care and allow people to access and update their own records.

24/7 care for people being cared for outside hospital.

A named senior clinician with overall responsibility for the delivery of good care for each person approaching the end of life.

Enabling family members and those important to the individual to be involved in discussions about care preferences and ensuring carers have support.

Training and work force numbers to ensure that staff are supported to deliver good care.

The steps that health and social care organisations can take to create the right conditions to improve choice, including guidance for commissioners, working with the voluntary sector—in particular hospices—and robust metrics to measure improvements.

The review advises how more people can be cared for in their own home, as this is a key choice for many people approaching the end of their lives. It sets out the savings that more out-of-hospital care can achieve in acute care, as well as the additional investment needed in community health and social care services.

The Government will work with organisations in the health and care system to consider this advice and enable a full response later this year.

In the meantime, I can say that we fully support the review’s vision that every person should receive care in line with their choices and preferences, and we urge local health and care organisations to work together to ensure that this is achieved for as many people as possible.

In particular, we recognise that interoperable electronic health records play a central role in ensuring that people’s preferences and choices are recorded and shared with all involved in their care. Examples from across the country have shown that where these systems exist they can deliver real benefits to people at the end of life and form an important part of the culture change needed to deliver choice and person-centred care.

To help this happen, the Government accept the review’s advice that each person approaching the end of life should have a fully interoperable electronic health record, and should be able to access and add to their own records. This is in line with the ambition set out for all patients in the “NHS Five Year Forward View”.

I would like to thank the chair and the review’s programme board for their hard work and commitment. Finally, I would also like to thank all the contributors to the review, and in particular the people who responded to the review’s public engagement exercise.

A copy of “What’s important to me: A Review of Choice in End-of-life care” is available in the Library. Copies are also available at:

https://www.gov.uk/government/publications? departments%5b%5d=department-of-health

Attachments can be viewed online at: http://www. parliament.uk/writtenstatements

[HCWS301]

Epilepsy

Norman Lamb Excerpts

Thursday 26th February 2015 Commons Chamber

[The Minister of State, Department of Health (Norman Lamb)]

I take this issue extremely seriously. There has been an EU-wide review of the risks involved. The Medicines and Healthcare Products Regulatory Agency issued new guidance in January, and the British National Formulary has also been updated. The Department is considering the introduction of a “red flag” system to notify GPs of the risks posed to women of child-bearing age, and I personally am very keen to introduce such a system.

[Teresa Pearce]

I know that the Minister has met some of the mothers involved, and I am very grateful for that.

Women such as the one I have just mentioned are in desperate need of specialised guidance and support from their GPs, but there is no such support at present. GPs should be providing pre-conception counselling and tailored advice, but they do not appear to be taking that responsibility seriously. In 2012, a survey by Epilepsy Action revealed that 26% of women who had been pregnant in the last five years, or were planning to become pregnant, had never received counselling. That puts women and unborn babies at risk.

Pre-conception counselling should be fully embedded in the care pathway of all women with epilepsy and child-bearing potential, and there should be a specialist care pathway for all women with epilepsy to ensure that their pregnancies are flagged as potentially high risk. Every such woman should receive regular input from an epilepsy specialist and an obstetrician, and any breakthrough or worsening of seizures should be investigated as a matter of urgency. Will the Minister tell me what funding, training and planning are needed to implement those steps?

The co-operation of GPs and health care professionals is crucial to ensuring that any strategy actually works. I welcomed the stronger guidance that was released in January by the Medicines and Healthcare Products Regulatory Agency. It states that sodium valproate should not be prescribed to female children, female adolescents, women of child-bearing potential or pregnant women unless other treatments are ineffective or not tolerated. As the Minister said, the guidance followed a Europe-wide review. What steps will the Department take to ensure that it is fully implemented? Every woman taking an anticonvulsant has the right to an informed choice, but we know that information on the effects of sodium valproate on pregnancy was withheld from female patients in 1972. Following the European review in 2014, why has providing information to female patients not been made a mandatory action?

At this moment, the picture is bleak. A recent report entitled “Saving Mothers’ Lives” highlighted the failure to reduce maternal deaths from epilepsy over the past two years. If women with epilepsy were provided with support and health care tailored to their specific condition, it is likely that the number of maternal deaths would be reduced. The science is available to ensure that women with epilepsy can have successful pregnancies with the right support, but that must be universally available to all women with epilepsy since simple measures can decrease the risks associated with epilepsy in pregnancy. I have worked closely with women whose children have suffered from FACS and families who have been affected by the lack of information.

In particular, I have worked with Janet Williams and Emma Murphy, who run IN-FACT, the Independent Foetal Anti-Convulsant Trust, and I respect and admire them for their relentless commitment and dedication to raising awareness of this issue. I first met them just after I entered the House in 2010, when families were devastated following the withdrawal of legal aid for a class action against the manufacturers of the drug. After six years of preparation, that trial did not go ahead. I tabled an early-day motion, signed by 82 MPs, urging the Legal Services Commission to reconsider, but it did not. Last year, I wrote to the Department of Health to ask whether compensation would be available. I received a response from the Under-Secretary of State for Health, the hon. Member for Mid Norfolk (George Freeman), who is responsible for life sciences. He said:

“Compensation for people who believe they have been adversely affected by a particular drug is a matter for the judicial system”.

I also received one from the Minister of State, Department of Health, the right hon. Member for North Norfolk (Norman Lamb), who is responsible for care and support, who said:

“it would be inappropriate for ministers to intervene in or comment on matters which must remain for the judicial system.”

The fact is that these families have sought justice and done everything they can, but they have been denied support and denied justice. Will the Government act?

[Steve Baker (Wycombe) (Con)]

I ask the Government to take a close interest in the case of my constituent Jessica Monks, which I shall relate from the perspective of her parents. I am grateful to my hon. Friend the Member for South Thanet (Laura Sandys) for creating the opportunity for me to do so and for giving me the opportunity to inform myself about this important issue. I have been astonished by what I have learned.

I am glad to follow the hon. Member for Erith and Thamesmead (Teresa Pearce). As she will learn, I too will talk about issues of consent towards the end of my speech. It was shocking to hear what she set out about consent.

Jessica Monks was not just a cheerful but a positively joyful young woman. Her life and her untimely death are a case study in what can go badly wrong and what ought to be done. Jessica was born on 7 February 1996 and lived in Medmenham in my constituency. She suffered from epilepsy and was under the care of the neurology department of the John Radcliffe hospital in Oxford. I understand that she was learning to live very well with her condition.

Jessica died by suicide on Saturday 24 January 2015 as a result of a psychotic episode related to the epilepsy medication she was taking. She had been taking Zonisamide since about November 2013, but her seizures had not stopped. Her neurologist told her parents to keep an eye on her moods and to make an appointment with him immediately if her moods changed in any way.

Over Christmas 2014, Jessica, usually a joyful young woman, became noticeably low and withdrawn, very unlike her usual buoyant self. As requested, Mr and Mrs Monks attempted to make an appointment for Jessica to see her neurologist about her changing moods in early January, but despite several phone calls they did not receive a response. Her parents were concerned about her deteriorating mood so they made an appointment with her GP, who saw her on 8 January. The GP agreed that her mood had deteriorated but, crucially, felt that it was important to speak to her neurologist before prescribing any medication to help her mood improve.

On Friday 9 January, Jessica was admitted to Wexham Park hospital after taking an overdose of Zonisamide, oxcarbazepine and paracetamol. She was seen by a junior psychiatric nurse, and I am surprised that it was a nurse. I am sure that they do a wonderful job, but I would have thought that in such circumstances a consultant would have been appropriate. However, the nurse deemed her fit for discharge. Following a further attempted suicide on Monday 12 January, Jessica’s parents made another appointment to see her GP who again recommended that Jessica be prescribed an antidepressant but felt unable to do so until she had spoken to her neurologist. The GP did arrange an urgent psychiatric appointment for Jessica and, thankfully, the psychiatrist phoned that evening to make an appointment and offer out-of-hours support.

At the psychiatric appointment on 22 January, Jessica was diagnosed as suffering from a psychotic episode and was instructed to stop taking the anti-depressants immediately. The psychiatrist was concerned that the drug Jessica was taking was causing this psychotic side effect—which is, by the way, well known—and said she would speak to the neurologist that evening to discuss whether Jessica should cease taking the epilepsy drug Zonisamide.

On Saturday 24 January, Jessica died when she stepped in front of an oncoming train.

[Norman Lamb]

My hon. Friend is talking about a tragic case and I cannot begin to imagine what the family have been through. I am very happy to meet him to discuss further what lessons can be learned.

[Steve Baker]

I am extremely grateful to my right hon. Friend.

Mr and Mrs Monks feel that there was a significant breakdown in the care of their daughter, and I certainly agree with them. The speed and severity with which her mental health deteriorated due to her epilepsy medication were not considered a priority—they were not adequately prioritised—and they feel they have been badly let down by the medical professionals they saw in the days leading up to Jessica’s death.

Jessica’s death was apparently avoidable. We need to know why it was not avoided. There are a number of questions to be answered by the NHS and the investigation is ongoing, as, indeed, is the coroner’s inquest. I contacted the coroner before raising this case and they were content for me to do so. I will not run through all the questions, some of which are apparent, but I should like to ask in particular why was the consultant neurologist not more available? Why, when it is well known, as the Library brief explains, that some of this medication can cause these side effects, was more immediate, perhaps telephone, support not available in the event of an episode?

--- Later in debate ---

[The Minister of State, Department of Health (Norman Lamb)]

I congratulate my hon. Friend the Member for South Thanet (Laura Sandys) who has worked with my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan). Together they present a powerful case, and I join everyone in thanking my hon. Friend the Member for South Thanet for everything she has done in this Parliament. She will be very much missed, and her case today was all the more powerful because she has epilepsy and can speak with authenticity. What she said about stigma is right—I see it often in mental health, and it is exactly the same issue in this debate. The fact that not long ago someone with epilepsy could not marry is an extraordinary reminder of what we have been up against. This debate is timely and gives everyone the chance to focus on the condition and on how we can improve the lives of those who have epilepsy. I am pleased that the baton will be passed to the hon. Member for Walsall South (Valerie Vaz), who I am sure will ably continue to articulate the case for people who suffer from epilepsy.

The debate has been marked by reference to two tragedies involving young people, and my hon. Friends the Members for Wycombe (Steve Baker) and for Cheltenham (Martin Horwood) spoke incredibly movingly about the dreadful cases involving Jessica and Emily. We will all agree that we owe it to those two girls to do everything we can to improve the experience of people with epilepsy, and to avoid tragedies of that sort happening. It is important to raise awareness, not only among the public but among clinicians, of the condition and how best to respond to it.

I pay tribute to the work of organisations involved in campaigning and research into epilepsy. The Epilepsy Society is based in the constituency of my right hon. Friend the Member for Chesham and Amersham, and Epilepsy Action in Leeds is close to the constituency of my hon. Friend the Member for Leeds North West (Greg Mulholland). Young Epilepsy has also been mentioned, as has the important work done by SUDEP Action. I remember meeting its members when they were establishing the register, and, as my hon. Friend the Member for Cheltenham made clear, it has the potential to provide incredibly rich data and evidence to help us understand why sudden unexpected deaths occur, and how we can prevent them from occurring in the future. All those organisations are doing incredibly important work.

The hon. Members for Vauxhall (Kate Hoey) and for Easington (Grahame M. Morris) mentioned discrimination. They will understand that I cannot comment on an individual case—I am an ex-lawyer and cautious about these things—but the important point about combating disability discrimination, including for epilepsy, cannot be overstated. Where there has been discrimination, it is incredibly important that there are consequences and that lessons are learned to avoid such things happening in the future.

I cannot begin to do justice to all the important points raised in this debate, so I undertake to write to all hon. Members who have taken part and to respond on important points such as co-commissioning laser ablation treatment, which was mentioned by my right hon. Friend the Member for Chesham and Amersham, as well as many other issues.

[Kate Hoey]

When he leaves the Chamber today, will the Minister or one of his staff at least make a telephone call to get some more information about this young woman and London Underground’s behaviour?

[Norman Lamb]

I am certainly happy to explore that, although the hon. Lady will understand why I cannot get involved in the case.

The Government are committed to securing high-quality outcomes for people in England living with epilepsy, whose number is currently estimated at more than 450,000. There are many different types of epilepsy seizure, and although some patients have the condition from birth, others become epileptic later in life. For the majority of people with epilepsy, the condition can be well managed—my hon. Friend the Member for Leeds North West talked about the experience of people in Leeds and the excellent care provided by hospitals there—and they can lead independent and healthy lives. As such, the provision of services for these patients is the responsibility of local commissioners, who are best placed to manage services for local populations. It is critical, however, that those who require more specialised care can access the right services and treatments, which is why NHS England commissions such services nationally. That need not be undermined by co-commissioning with local areas.

The Government recognise the importance of ensuring that patients with suspected epilepsy are diagnosed swiftly and accurately. As most people will be aware, seizures are the main symptom of the condition, and it is common practice for anyone who has experienced such seizures to be referred for assessment by a specialist. Neurological conditions such as epilepsy are part of the generalist undergraduate medical curriculum and a component of GP training. As such, GPs should be able to manage, monitor and appropriately refer the epileptic patients in their care. In secondary care, there are nearly 2,000 full-time equivalent neurologists, and for 2015-16 Health Education England has made a commitment to invest in 217 neurological specialty training places. In addition, specialist epilepsy nurses should be a key element of both routine and specialist neurological care, as set out by NICE and NHS England respectively. I know that my hon. Friend the Member for Southend West (Sir David Amess) has concerns in his locality, but it ought to be part of the picture in each area.

To support clinicians in the management of this condition, NICE has published a guideline setting out best practice on the diagnosis, treatment and care of patients. The guideline recommends that referrals for patients with suspected epilepsy are urgent, with patients being seen within two weeks, if possible. I think that the hon. Member for Vauxhall mentioned a wait of two months. That is not acceptable and should not happen, and the local organisations responsible for the delays should be held to account. If it is possible in other areas of the country, it ought to be possible everywhere.

In addition, if seizures are not controlled or diagnosis is uncertain, people should be referred to a specialist service within four weeks. Most people with epilepsy can have their condition successfully controlled with anti-epileptic drugs, and there are more than 25 types of drugs with which to achieve seizure control. The NICE guideline makes it clear that treatment should be individualised according to the seizure type, epilepsy syndrome, co-medication and life style. On the point made by the hon. Member for Erith and Thamesmead (Teresa Pearce), women with epilepsy wanting to conceive must—absolutely must—be given accurate information and counselling about medication such as sodium valproate. That is critical. I mentioned that the Department was considering the possibility of a red flag system, and I hope it will be possible to achieve that.

For some people with more complex conditions whose epilepsy is more difficult to control, other procedures, such as surgery or vagus nerve stimulation, might be appropriate. Patients whose epilepsy is particularly difficult to treat may be referred to a specialist neurological care provider. In particular, children with epilepsy should be considered for specialised care at an early stage, because of the developmental, behavioural or psychological effects associated with suffering from continuing seizures.

In conclusion, this has been an incredibly important debate, and I will do everything I can to follow up all the important points raised.

Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 24th February 2015 Commons Chamber

[The Minister of State, Department of Health (Norman Lamb)]

HM Treasury’s costing demonstrates the limitations of data available nationally in estimating the potential costs of providing free personal care at the end of life. That is why the Department of Health is undertaking further work with stakeholders to develop an evidence base to inform the next spending review.

[Dr Wollaston]

I thank the Minister for that reply. He will know that most people want to be able to remain at home at the end of their lives, surrounded by the people they love, and I pay tribute to all the carers, volunteers and health professionals, including Rowcroft’s hospice at home, who help to make that possible. Sadly, he will also know that often the situation can break down because of the sheer exhaustion of caring for a loved one at the end of their life. Will he commit that the Government will consider the quality of care as well as the costs when considering introducing free end-of-life social care?

[Norman Lamb]

I thank my hon. Friend for that question and join her in paying tribute to the work of so many people: volunteers, loved ones and the professionals working in the community. The whole emphasis should be on ensuring that we respect people’s choice about where they want to be and that they get the best possible care. Later this week, the independent review of choice at the end of life will be published and I hope that it will inform discussions. I am completely with her in trying to ensure that we can achieve this.

[Lisa Nandy (Wigan) (Lab)]

One of my constituents recently went through a lengthy, distressing and difficult process to get NHS continuing care for his wife. If we remove the distinction between NHS and social care, many people across this country, including my constituent, will be spared this distress and difficulty at one of the hardest times in their lives. We know that funding should be put where it is needed and we know that that will be more cost-effective in the long run and will be better for patients, so why will the Minister not act?

[Norman Lamb]

Actually, we are all agreed on this. We all want free care at the end of life, but whoever is in power after the election in May will have to ensure that we understand fully the costs. There is a lot of evidence, and the evidence is growing. We are having very good discussions with groups involved in care at the end of life and we all want to achieve a solution. Of course, the truth is that very many people are receiving free care at the end of life, but they are in hospital, where they often do not want to be. I am completely with the hon. Lady in trying to achieve this.

[Paul Burstow (Sutton and Cheam) (LD)]

Eight out of 10 people say that they would prefer to die at home when their time comes. Since the Government published their White Paper and said that they saw merit in social care being free at the end of life, a succession of reports from Macmillan, Nuffield and others have shown that there are savings to be made and benefits in terms of more dignified deaths and compassion for families. Is it not time to act on the evidence and make social care free at the end of life?

[Norman Lamb]

We very much hope that the case will stack up. As I said earlier, we are in active discussions with these groups and I held a round table with them a few months ago to discuss how we can achieve this. Everyone is agreed on the objective, but we need to understand the full costs involved before any Government can make a commitment to it.

[Mr Frank Field (Birkenhead) (Lab)]

Is there not something deceitful about the Government’s promising major changes for the next Parliament when we do not know how they will be paid for? If we want improvements to the NHS and end-of-life care in the next Parliament, Members on both sides of the House need to put before the electorate how we will pay for those important long-term changes.

[Norman Lamb]

I am tempted to say that that is a bit rich coming from an Opposition Member. I am sure that he would agree that whatever commitments are made, we need to understand their cost. That work is under way and I hope that as soon as we achieve a full understanding we can proceed.

[James Morris (Halesowen and Rowley Regis) (Con)]

8. What assessment he has made of the potential of the genomics programme to improve cancer treatment.

--- Later in debate ---

[Sir Bob Russell (Colchester) (LD)]

10. What guidance he has given to clinical commissioning groups and mental health trusts on jointly funding not-for-profit voluntary and charitable organisations providing support for people with mental health issues.

[The Minister of State, Department of Health (Norman Lamb)]

The Government are clear that voluntary organisations and charities make an important contribution to the delivery of local health and social care services, including services that support people’s mental health needs. However, it is the responsibility of local commissioners to commission appropriate services based on their local population’s needs.

[Sir Bob Russell]

The Minister will be aware that although the NHS is one organisation, trusts seem to operate as silos. Will he convene a meeting of all the trusts in the Colchester area to discuss the future of the Haven project?

[Norman Lamb]

I visited the Haven last week with my hon. Friend, and I was enormously impressed by everything I heard, including the extraordinary testimonies of people with personality disorders who had benefited so much from the Haven’s service. In my view, it would be incredibly sad and very worrying if that service were to be lost. I am happy to invite the clinical commissioning group and the mental health trust to a meeting in the Department to discuss how it can be saved.

[Kevin Barron (Rother Valley) (Lab)]

I recently met the five UK Youth Parliament Members from Rotherham, who talked about the lack of facilities for mental health help in education, both further education and state education. May I say to the Minister that it is all right saying that it is up to local commissioning groups, but where is the leadership, when our young people are being left in extremely difficult situations and are seen by some professionals but, sadly, not health professionals?

[Norman Lamb]

The local Members of the Youth Parliament the right hon. Gentleman met make an incredibly important point. I refer him to the children and young people’s mental health and well-being taskforce, which will report very soon. I think that the role of schools will be crucial in its conclusions, and I encourage him to look at the report when it emerges.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

The latest figures show a huge rise in the number of young people with a mental illness turning up at A and E. Young people not getting the help they need early on and becoming so ill that they need hospital care shows that the system is failing. Does the Minister accept that this Government’s decision to cut children’s mental health services at the same time as wasting £3 billion on a reorganisation has been a key factor in that failure?

[Norman Lamb]

This Government have absolutely not made any decision to cut children’s mental health services, and the hon. Lady knows it is misleading to suggest otherwise. These decisions are taken by local commissioners in local authorities and CCGs. Indeed, we have legislated for parity of esteem for mental health. I urge her to look at the outcome of the work of the children and young people’s mental health and well-being taskforce, which I think gives us a real opportunity to improve the way in which services operate.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

11. How many nurses per million population were working in the NHS in each of the last five years.

--- Later in debate ---

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

12. What discussions he has had with (a) the Haven project in Colchester and (b) NHS bodies in north Essex on the need for continuing funding for support for people with moderate to severe personality disorder.

[The Minister of State, Department of Health (Norman Lamb)]

My right hon. and noble Friend the Under-Secretary of State with responsibility for quality responded in February 2014 to correspondence from the client chair of the Haven project about its funding. As I said a few minutes ago, decisions on NHS funding are a matter for local commissioners, but I will invite North East Essex clinical commissioning group to meet to discuss the issue in more detail.

[Mr Jenkin]

I am grateful to my right hon. Friend for taking such a close interest in the matter, and for the visit paid by the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter). Although I understand the huge cost pressures on the CCG, may I invite my right hon. Friend to study the Enable East report, which made a different recommendation on how the unit should be treated? It would be sad to close the leading example among 11 Department of Health pilots, when all the other 10 are being kept open as the lessons learned are so valuable.

[Norman Lamb]

I am very much aware of the work that my right hon. Friend and my hon. Friend the Member for Colchester (Sir Bob Russell) have done on this. It is interesting that all the other 10 pilots have continued. They are part of NHS trusts. This is the only one run by a voluntary sector organisation. It is an incredibly valuable service. I was struck by the extent to which people said how much they had reduced their hospital in-patient admissions as a result of the incredibly impressive preventive work that this service provides, and I want to look into it further.

[Andrew Griffiths (Burton) (Con)]

14. What support the Government are giving to people with Ehlers-Danlos syndrome.

--- Later in debate ---

[Philip Davies (Shipley) (Con)]

15. What estimate he has made of the number of admissions to A & E in the last three years for patients with palliative care needs in (a) areas with a 24-hour palliative care helpline or palliative co-ordination centre and (b) areas that do not offer such services; and if he will make a statement.

[The Minister of State, Department of Health (Norman Lamb)]

We know from local examples that areas that offer 24/7 community palliative care services have been able to reduce the number of A and E attendances and inappropriate hospital admissions, including emergency admissions, for people with palliative care needs. I would encourage all areas to offer these services in line with the NICE quality standard.

[Philip Davies]

A poll conducted by Sue Ryder shows that 82% of people expect advice to be available 24/7, yet only 8% of CCG areas have a dedicated around-the-clock palliative care helpline and co-ordination centre. As I am sure we all agree, carers do wonderful work and need as much support as possible. Will my right hon. Friend’s Department work with Sue Ryder and others to ensure that there is a dedicated 24/7 palliative care service, which would certainly help to take the strain away from A and E, which is already under great pressure?

[Norman Lamb]

I pay tribute to the professionals in my hon. Friend’s area, which is one of the leading areas for providing strong support in the community, which prevents unnecessary hospital admissions. I am very happy to work with Sue Ryder and others to try to get the message across that if this can be provided throughout the country we will improve the experience of people at the end of life, but critically also save costs further down the line by stopping inappropriate hospital admissions.

[Mary Macleod (Brentford and Isleworth) (Con)]

16. What his priorities are for improving mental health care.

[Mr Speaker]

Minister Lamb.

[The Minister of State, Department of Health (Norman Lamb)]

Mr Speaker, you sounded a note of tedium in calling my name again.

[Mr Speaker]

I feel no sense of tedium but almost a state of ecstasy upon calling the right hon. Gentleman. If I gave any other impression, I most heartily apologise to him. I hope that he is now assured of his status in the affections of the Chair, if, possibly, also of the House? There might have to be a Division on that proposition. I do not know.

[Norman Lamb]

I am so grateful to be reassured, Mr Speaker.

Mental health is a priority for this Government. We have legislated for parity of esteem between mental and physical health, invested £400 million in talking therapies, significantly reduced the numbers of people who are placed in police cells during mental health crises and are introducing the first waiting times standards for mental health services from April this year.

[Mary Macleod]

I recently met a constituent at one of my advice surgeries who had been refused NHS mental health care because she was told that she was entitled to only one batch of free support. Considering how complicated and varied mental health issues can be, is there anything we can do for people who need more support after a relapse of mental ill health?

[Norman Lamb]

If that was the advice the hon. Lady’s constituent received, it is complete and utter nonsense. The idea that someone can have only one episode of care under the NHS is so ridiculous that it hardly merits a proper response. I urge her to encourage her constituent, with her support, to go back to those local services and ensure that she gets further support if she needs it, as she is entitled to it.

[Neil Parish (Tiverton and Honiton) (Con)]

17. What assessment his Department has made of the future role of community hospitals.

--- Later in debate ---

[Annette Brooke (Mid Dorset and North Poole) (LD)]

T5. I have previously made Ministers aware that there are no beds for females in Dorset who need intensive psychiatric care. Our local newspaper, the Daily Echo, reports that such places will not be provided in Dorset for another three years. Meanwhile, patients are being sent as far away as Bradford. Do Ministers regard that as satisfactory? Are there enough resources coming to Dorset, or is it a local organisational issue?

[The Minister of State, Department of Health (Norman Lamb)]

No, I do not regard that as satisfactory and I am happy to talk to the local commissioners. We have ensured that there will be real-terms increases in mental health funding for 2015-16, and that should be regarded locally as a matter of urgency.

[Mr David Crausby (Bolton North East) (Lab)]

T6. Bolton’s accident and emergency department has been in crisis recently, partly because the clinical commissioning group closed the town’s walk-in centre. Will the Secretary of State support my petition calling for its reinstatement, or will he say, more predictably, “It’s not me, guv; I’m just the Secretary of State for Health”?

[Duncan Hames (Chippenham) (LD)]

What alternatives do clinical commissioning groups have to a full-scale commercial procurement when their existing contracts for community health services approach the time when they have run their course?

[Norman Lamb]

That is a matter for local commissioners. There is no requirement on them to tender competitively if their judgment is that it is right for the local community that services remain with the existing provider. We have been very clear that that is a matter for local commissioners.

[Graeme Morrice (Livingston) (Lab)]

T7. My constituent Wilma Ord was prescribed Primodos in the 1970s, an oral hormone pregnancy testing pill that she blames for her daughter’s birth defects. As the Secretary of State is aware, it was announced back in October that an inquiry would be established to look into the whole issue. What progress has been made in setting up the inquiry and what assurances can he give my constituent, and the many other women and families affected throughout the country, that the inquiry will be fully comprehensive, transparent and independent?

NHS Mental Health Care

Norman Lamb Excerpts

Wednesday 11th February 2015 Westminster Hall

[The Minister of State, Department of Health (Norman Lamb)]

Thank you very much indeed, Mr Pritchard, for calling me to speak. It is good to serve under your chairmanship.

I congratulate my hon. Friend the Member for Portsmouth South (Mr Hancock) on securing this debate; I know that he has been trying to secure such a debate for some time. I particularly congratulate him for speaking out about his own mental ill health, because it is at the heart of changing attitudes and addressing the stigma that he and other hon. Members have talked about that people who have been successful in life should speak out and explain that they themselves have suffered mental ill health. Every time someone speaks out about their own mental ill health, that makes it easier for a youngster to be open about their own issues and seek help. That is the critical change that is needed, so that mental health comes out of the shadows and we lose the embarrassment about discussing it.

I commend to hon. Members the brilliant campaign, Time to Change, which this Government have funded, along with Comic Relief. It is all about tackling stigma. Interestingly, attitudes are changing. They are being measured on a regular basis and the dial is moving; people feel more able to talk about their mental ill health.

[Mr Nigel Evans]

I am extremely grateful to the Minister for what he has just said. When I was 27, I had depression for a year. I did not know where I was; I did not know whether I was going to come through it. It was awful. I received support from a lot of people who loved me and who got me through that particular period. Then I became an MP and eventually Deputy Speaker of the House of Commons.

The one thing that we must give people is hope, and I hope that the Minister’s response to this debate will be one not only of understanding—he has already expressed that—but of hope for people out there and their families, who look on, feel dejected and want support.

[Norman Lamb]

I totally agree. I hope to be able to convey some sense of optimism, actually, because, despite all the challenges that my hon. Friend the Member for Portsmouth South referred to, there are very some exciting things happening, which are laying the foundations for genuine equality for mental health. We have legislated in this Parliament for parity of esteem, but to be honest I am not interested in empty rhetoric—our words must mean something for people in need of help.

My hon. Friend referred to many aspects of the system that need to improve significantly. I will deal briefly with one—the issue of beds. We must be a bit nuanced here. It is absolutely clear that when there is a moment of crisis a bed must be available, and available locally. Incidentally, we should also look at places such as recovery houses. Increasingly, there are lots of third sector organisations that provide recovery houses around the country and it is often better for people to go into a place such as that than to be an in-patient admission, which might not be the best thing therapeutically for them. But the idea that in a middle of a crisis someone is shunted somewhere else in the country, or even put into a police cell, is really an outrage in a civilised society.

The interesting thing is that when I came into this job I realised more and more that I was operating in a fog. The data that we are absolutely used to when it comes to physical health, and the scrutiny of that data and evidence, have simply been lacking when it comes to mental health. Traditionally, we have not collected the information about access to services and what is happening to people on the ground, and that has been a fundamental issue that I have sought to address.

On out-of-area placements, I had no idea from the data that came to me about what actually happens around the country. Last week, we finally got the first sight of real data, which will now be provided on a regular basis, so that we can hold trusts to account if they fail to meet local need. The fascinating thing is that there are many trusts around the country that have no out-of-area placements at all under existing financial circumstances, while there are others that completely fail and are sending many people out of area. We need to understand why that is happening and address the causes, whether they are in commissioning, in the provider organisation or because of lack of funds, because some areas have demonstrated that that is not necessary.

[Mr Mike Hancock]

I entirely accept the idea that, when a bed is needed, a bed needs to be found. However, that person is at the very start of the crisis that made them seek help. They are shifted several hundred miles across the country, settled in and then, because the NHS suddenly finds a bed available half way back to their home, they are moved there without being given a chance to get used to the idea that they are getting help.

[Norman Lamb]

My hon. Friend does not need to convince me of that. I am completely with him and I am determined that we should eradicate this practice, which is unacceptable for people in a moment of crisis.

The use of police cells is a practice that has always gone on. Actually, because of the crisis care concordat that we published last February, for which 20 national organisations came together to set standards for crisis care in mental health for the first time ever, this year we will see a 50% reduction compared with two years ago in the number of people going into police cells. That is a real advance. We must go further and completely eradicate under-18s going into police cells. We have said that we want to ban the use of police cells for under-18s and to make such use an exceptional event for anyone else.

I want to try to deal with what we are doing to convey a sense of optimism, because I think that we are now on the right track. My hon. Friend painted a picture of the situation. There is, in my view, discrimination at the heart of the NHS, where people who suffer from mental ill health are disadvantaged compared with those with physical health problems. That must end. Access and waiting time standards were introduced in the past decade, so those who are thought to be suffering from cancer get to see a specialist within two weeks. Why does a youngster who suffers a first episode of psychosis not get that right? We cannot begin to justify that. We are therefore introducing, for the first time ever, access and waiting time standards in mental health from April so that, for a youngster suffering a first episode of psychosis, the standard will be to start treatment within two weeks. We will start with 50% of people and progressively increase that.

My hon. Friend talked about psychological therapies. There will be a standard of access within six weeks for 75% of people, with a 95% backstop to start of treatment within 18 weeks. That is what transformed care in physical health in the past decade. As Sir Mike Richards, who was the cancer tsar in the last decade, said to me, we can achieve the same transformation in mental health by applying the same rights of access that we have had in physical health for some considerable time. That complete imbalance of rights between mental and physical health dictates where the money goes, and that must end.

[Mr Hancock]

I will be very quick. This issue is made worse: Mind carried out a survey of all local authorities in England and found that, on average, they allocated just 1.36% of their public health budget to help people avoid developing mental health problems. Some planned to spend nothing at all. I want to see the Minister put pressure on local authorities to have such programmes that may, just may, keep people alive.

[Norman Lamb]

Indeed, I have done exactly that. The sense is that this issue is hidden away from public view. It is not recognised that there is an extraordinarily powerful invest-to-save argument to be made, as my hon. Friend said. If we invest in public mental health and early access to therapies, whether psychological therapy or therapy for eating disorders or psychosis, there will be a return on that investment, but, critically, the individual will be helped to recover and to be able to lead a good life again. That is the challenge that we face.

Alongside announcing the first ever waiting time standards, we published a vision for making them comprehensive throughout mental health in the next five years. I want all parties to commit to implement those standards through the next Parliament so that, just as Sir Mike Richards suggested, we can achieve genuine equality for those who suffer mental ill health.

The crisis care concordat set standards for what should happen in a crisis. Across the country, we are seeing a dramatic reduction in the use of police cells, which is a very good thing. We are investing more in liaison psychiatry so that for the first time those who turn up in A and E suffering from mental ill health get access to someone who knows something about it. At the moment, people often turn up in A and E and find that they cannot see anyone with the relevant specialism. That must end, so we are investing in liaison psychiatry.

On children and young people, which my hon. Friend raised in particular, I set up a taskforce last summer, bringing in experts from outside Whitehall such as YoungMinds, the campaigning organisation. We have engaged with young people. The taskforce will publish a report soon. That is the opportunity to fundamentally modernise children’s and young people’s mental health services.

There is a funding issue. More funding is needed—some areas of the country have cut investment ridiculously in young people’s and children’s mental health services—but there is also the question of how the money is spent. Such services are commissioned in a horribly fragmented way and there is not nearly enough focus on what can be done in schools to build resilience and focus on mental well-being. If we were to do that much more effectively, we could stop the deterioration of health.

On liaison and diversion, it is a scandal of our time that so many people suffering from mental ill health end up in prison, largely because their illness drives offending behaviour. Yet so many of those people have never had access to the sorts of therapies that could help them to recover. When someone who is suffering from mental ill health turns up at a police station or a court, liaison and diversion is all about diverting them into treatment. We have 25% of the country covered now and we will cover more than 50% from April with a view to covering the whole country by 2017. No other country in the world is doing that on such an industrial scale, and we should be proud of that.

On access to psychological therapies, which my hon. Friend talked about, waiting times are far too long; that is why we are introducing a maximum waiting time standard. However, in 2010 about 300,000 people got access to psychological therapies. This year that figure will hit about 900,000—a tripling of that number.

[Mr Hancock]

That shows the size of the problem.

[Norman Lamb]

It does, absolutely. The next challenge is to bring the improving access to psychological therapies programme into line with Jobcentre Plus. We are working on that, with pilots around the country. It is ridiculous that there are so many people out of work, languishing on benefits through no fault of their own because of their mental ill health and not getting access to the therapies that could help them recover. That has to change. We must link mental health services much more closely with employment services, schools and the criminal justice programme.

There are significant areas where mental health services fall short and, as my hon. Friend rightly said, they have always done so. However, as the Minister responsible, I am on a mission—[Interruption.]

[Mark Pritchard (in the Chair)]

Order. We have a Division, so will the Minister bring his remarks to a conclusion, please?

[Norman Lamb]

I congratulate my hon. Friend and I think that we are on the way to achieving genuine equality for mental health.

Care and Support Appeals System

Norman Lamb Excerpts

Wednesday 4th February 2015 Written Statements

[The Minister of State, Department of Health (Norman Lamb)]

Today I am publishing a consultation on draft regulations and statutory guidance to introduce the cap on care costs system that will complete the historic reforms set out in the Care Act. For the first time ever, the cap will protect people from the risk of catastrophic care costs and offer more people means tested financial support towards the costs of their care. Also included in this consultation are policy proposals for a new system of appeals that will enable people to challenge certain decisions made by local authorities under the Care Act.

This consultation continues the collaborative approach we have taken throughout the care and support reform programme and seeks views on the elements of the reforms that are due to come into force in April 2016.

Part one of the consultation focuses on funding reform and seeks views on draft regulations and guidance that will introduce the cap on care costs and extend access to means-tested financial support. The draft regulations and guidance set out the detail of how we propose to implement these reforms enabling local authorities to plan and prepare for implementation. Alongside this, the consultation sets out a small number of areas that we wish to further explore.

The introduction of a cap on care costs will provide people with greater clarity about what they will be expected to contribute towards the cost of their care and what help they can expect from the state. This will not only bring people much needed protection and peace of mind, but also certainty that will enable them to better plan and prepare. The extended access to means tested financial support will mean that more people will be eligible to receive financial support from their local authority towards their care costs.

Part two of the consultation seeks views on policy proposals for a new system of appeals for care and support under the Care Act and the need for a new system. These policy proposals flow from the broad consensus of support for a right of appeal that emerged as the Act progressed through Parliament. The policy proposals set the framework for a cost effective system for people to appeal against certain decisions made by local authorities under the Act which focuses on achieving early resolution.

I am placing a copy of the documents relating to this consultation in the Library of the House. These are also available on the Government’s website at: http://careact2016.dh.gov.uk. These comprise a consultation document, draft statutory guidance and regulations on the cap, policy proposals for an appeals system and an impact assessment.

[HCWS250]

Child and Adolescent Mental Health Services

Norman Lamb Excerpts

Monday 2nd February 2015 Commons Chamber

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the availability of child and adolescent mental health in-patient beds, and on child and adolescent mental health services more generally.

[The Minister of State, Department of Health (Norman Lamb)]

Since April 2013, NHS England has been responsible for commissioning in-patient child and adolescent mental health services—CAMHS—often referred to as tier 4 CAMHS. In 2014, NHS England reviewed in-patient tier 4 CAMHS and found that the number of NHS-funded beds had increased from 844 in 1999 to 1,128 in 2006. That has now risen to more than 1,400 beds, the highest this has ever been. These data are now being collected nationally for the first time, but despite the overall increase, NHS England also found relative shortages in the south-west and areas such as Yorkshire and Humber.

In response, the Government provided £7 million of additional funding, allowing NHS England to provide 50 additional CAMHS specialised tier 4 beds for young patients in the areas with the least provision—46 of these beds have now opened. NHS England has also introduced new processes for referring to and discharging from services, to make better use of existing capacity. A key objective of these actions is to help prevent children and young people from being referred for treatment long distances from home, except in the most specialised cases.

National availability of in-patient CAMHS beds is reviewed each week by NHS England specialised area commissioning teams and the national lead for commissioning, identifying any issues and taking proactive steps to address them. On 30 January, it emerged that the number of general CAMHS beds available was lower than in recent weeks. In response, NHS England implemented contingency plans, including contacting existing CAMHS providers to seek additional capacity and increasing the use of intensive home support packages to allow children and young people to be treated at home or on a non-specialised ward. NHS England has also contacted mental health providers to alert them to the immediate capacity issues in CAMHS and establish what capacity existed in adult in-patient and community services to take cases on a temporary basis, should that option be required.

The Government are committed to improving CAMHS as part of our commitment to achieving parity of esteem between mental and physical health—this is not just for in-patient services, but for services in the community, and for services that seek to intervene early and prevent problems arising. That, ultimately, is where the focus must be to ensure that, as far as possible, we spot issues early and prevent them from worsening, reducing the need for in-patient treatment.

In August 2014, the Department of Health set up the child and adolescent mental health and well-being taskforce. The taskforce brings together a range of experts from across health, social care and education. It will consider how we can provide more joined-up and accessible services built around the needs of children, young people and their families. A Government report on the taskforce’s findings will be published in the spring.

The Government have also invested £54 million in the children and young people’s improving access to psychological therapies programme and will invest £150 million over the next five years in improving services for those with eating disorders.

[Luciana Berger]

All over England, our child and adolescent mental health services are increasingly under pressure. Despite the best efforts of NHS staff, the system is now in crisis. Children are being sent hundreds of miles for treatment or detained in police cells because there is nowhere else for them to go. We are also hearing of young people getting no treatment at all. I was appalled to see the copy of the e-mail that NHS England commissioners sent on Friday night, warning mental health trusts of a national shortage of in-patient beds for children. It was almost one year ago that the chief executive of YoungMinds said that the increase in the number of children placed on adult wards was entirely predictable following cuts to mental health services. Why did the Minister not act on that warning and do something to prevent it from happening?

The e-mail from NHS England said that the shortage would make it likely that 16 to 18-year-olds would need to be admitted to adult wards. Senior inspectors at the Care Quality Commission say that under-18s should not be put on adult wards, so why is NHS England issuing guidance that contravenes that advice? Adult mental health wards are no place for young people, but how can the Minister be sure that even in emergencies adult wards can accommodate children and teenagers? Adult mental health wards are operating at well over their recommended capacity, and today the Royal College of Psychiatrists has warned that the lack of acute beds available to mental health patients has left the system at breaking point. If adult mental health wards are full, where will these children go? What assessment was used to determine how many beds were needed? Clearly, it is not working. Does the Minister now plan to reassess the situation?

Why are so many of our children and young people needing in-patient mental health care in the first place? Could it have anything to do with the £50 million of cuts to child and adolescent mental health services? The Minister talked about early intervention, but we have seen cuts to early intervention in psychosis services, cuts to crisis services in the community, and the decimation of the early intervention grant, putting a lot of pressure on in-patient services. Could the problem be the fragmentation of commissioning we have seen across the health service since the Government’s reorganisation of the NHS?

The Government have paid lip service to parity of esteem and brought cuts and crisis in reality. Our children deserve better, and that is why Labour is committed to working to reverse the damage done to child and adolescent mental health services by this Government and why we have pledged to end the scandal of the neglect of child mental health.

[Norman Lamb]

First, let me caution against sanctimony. This is not a new issue: under the previous Labour Government, children did at times end up in adult wards. That is highly undesirable—everyone recognises that—and we must do everything we can to prevent it, but please do not try to claim that this is an entirely new problem. It is not. The Government have significantly increased the number of beds available, so significantly more are available now than there were in the last decade. The hon. Lady says that she sees increasing numbers of children held in police cells, but let us have some honesty and accuracy in this debate. The number of children who end up in police cells is falling, not increasing. The crisis care concordat, published last February, set a commitment to end the practice of children going into police cells. Indeed, we intend to legislate to ban it, but the numbers are lower than they were so she should not suggest that it is a growing problem—[Interruption.] She did suggest that.

The hon. Lady asked about my acting on the warning. That is exactly what we did. NHS England carried out a review of clinical judgment on the capacity required to meet children’s needs. As a result, there was a proposal for an increase of 50 beds nationally, focusing on the areas of the country where there was a significant problem, and the Government provided £7 million of additional funding to ensure that those beds were opened. Forty-six beds have opened. There is a temporary problem in Woking, where beds that were available are no longer accepting new admissions. That is a CQC issue. One thing that we have been absolutely steadfast on is that if standards are not being met, we should not continue to admit children to those wards.

The hon. Lady mentioned psychosis services, but this Government, for the first time ever, introduced a waiting time standard for early intervention in psychosis, which was widely welcomed by everyone in the mental health world. From this April, we start the process of introducing a standard. To start with, 50% of all youngsters who suffer a first episode of psychosis will be seen within two weeks and start their treatment within two weeks. That is an incredibly important advance.

The hon. Lady lectures the Government on mental health services, but perhaps she will consider why the Labour Government left out mental health when they introduced access and waiting time standards for all other health services. That dictates where the money goes and means that mental health loses out. This Government are correcting that mistake.

[Dr Sarah Wollaston (Totnes) (Con)]

I welcome the extra beds committed to south Devon. The Minister will know that one of the most frequent points raised with the Health Committee in our recent CAMHS inquiry was the complete absence of accurate prevalence data on children and adolescents’ mental health needs and the services required to meet them. He will know that the prevalence data collection that used to happen every five years was cancelled in 2004. The Committee warmly welcomed the commitment to restart that survey. Will he update the House on exactly when that survey will start, whether the funds have been identified, and whether the scope of the prevalence data collection has been identified?

[Norman Lamb]

The hon. Lady is absolutely right. Unless we understand the prevalence of the problem, it is impossible to plan services effectively. I am delighted that we have secured the funding for an updated prevalence survey in 2015-16. It will be an expanded survey compared with the previous one. We want to cover as wide an age range as possible, to cover early years. That will give us the data, information and evidence we need, but I would then want us to do regular repeats to ensure that we maintain an understanding of prevalence.

[Alan Johnson (Kingston upon Hull West and Hessle) (Lab)]

The excellent in-patient facility in Hull and East Yorkshire closed under this Government in 2013 with no consultation whatever. Despite an excellent report by the Health Committee, despite criticism by the CQC and despite NHS England identifying a problem, we have waited two years. Does the Minister believe that the Health and Social Care Act 2012 has made him powerless to act in such cases? If not, why does he not do something?

[Norman Lamb]

Ultimately, it has to be down to clinical decisions. Indeed, the whole thrust of policy, which was very much started under the right hon. Gentleman’s Government and during the period that he was Secretary of State for Health, is to devolve decision making about the make-up of services to local areas. That approach has been maintained. Ultimately, he would probably agree that such issues cannot all be determined in a Whitehall office.

None the less, the right hon. Gentleman raises serious concerns. I have tried to engage with him on them and am happy to talk to him and meet him further. I share his concerns about the lack of sufficient response to the concerns he raises, but I will repeat one other point I have made: the emphasis of policy should be on building up crisis response services and better and stronger community support services to reduce the need for in-patient care as much as possible. It is not therapeutic to put children and young people on in-patient wards, and particularly not away from home.

[Paul Burstow (Sutton and Cheam) (LD)]

I can recall many Labour Health Ministers telling us from the Dispatch Box that local decisions were made by primary care trusts and were not a matter for them. Will the Minister consider what he has told us about the CAMHS review? He has been frank about the fact that CAMHS are dysfunctional and broken. Surely the review is the opportunity to lay down a route map and set out how we can deliver the preventive early intervention services that prevent the crisis from occurring in the first place and the need for the admission. Do we not need that so that when there is a spending review after the general election, there is clarity about the investment needs for children’s mental health?

[Norman Lamb]

I think my right hon. Friend is referring to the children and young people’s taskforce that I established last summer. He is right that this provides us with an incredibly valuable opportunity to modernise the way in which we organise and commission children’s mental health services. There are many fantastic professionals working in children’s mental health services, but in my view they are let down by a dysfunctional system with horribly fragmented commissioning, which is a long-standing problem. Because we are involving experts and campaigners from outside and, critically, children and young people, we have a great opportunity to get services modernised and effective and focusing particularly on prevention.

[Glenda Jackson (Hampstead and Kilburn) (Lab)]

The Minister seems to be arguing that the solution to the problem is further evidence. For all the years that I have been in this House—almost 23 now—the issue of underfunding for mental health has been constant. The underfunding of services for children and adults who are suffering from mental health problems is an issue I raised in this House less than six weeks ago. It is unacceptable to claim that if there had been more information, measures would have been put in place to prevent children being sent hundreds of miles from their homes or being placed in adult wards. The Minister’s contribution has clarified the total lack of co-ordinated services for these young people. What kind of care would be afforded to someone in their home when, as in my constituency, their home may well be bed and breakfast, a hostel or some form of temporary accommodation? This is an urgent question; it requires urgent action. [Interruption.]

[Mr Speaker]

Somebody said that was very wrong. It was a Shakespearian performance. In fact, somebody once said to me, “That person could have been on the stage”!

[Norman Lamb]

I am delighted that the hon. Lady made the point not made by her Front-Bench spokesperson, which is that this is a long-standing problem. The disadvantage suffered by mental health has been there for a long time. Indeed, it was exacerbated, if I may say so, by the fact that access and waiting time standards were introduced for physical health, but the previous Government left out mental health. If that happens, it dictates where the money goes. That, combined with a funding system that sucks money into acute hospitals but which in mental health relies on a block contract, means that mental health always loses out. It is this Government who are determined to change that to ensure that mental health is finally treated equally.

[Tim Loughton (East Worthing and Shoreham) (Con)]

The Government can take credit for great progress in eliminating mixed-sex wards. The Home Secretary had some very encouraging things to say about children with mental health problems in police custody, and in the Department for Education great strides have been made in respect of kids in residential care homes not being placed well away from home. Many of us fought very hard during the passage of the Mental Health Act 2007 to get rid of the practice of children being placed in adult wards far from home. Will the Minister now, with the same urgency that led to those other successes, ensure that that is eliminated at last? In many cases it is not in the best interests of deeply troubled children.

[Norman Lamb]

I pay tribute to the hon. Gentleman for the work he did in his campaigning on the Mental Health Act and more recently as a Children’s Minister in the Department for Education. I know his passion for the subject and I share his view that it is intolerable that children and young people should go to adult wards. It has been a long-standing issue—it is not new—but it should not happen, just as it should not be the case that children are still placed in police cells. That is why I take the view that we need to ban it in law so that it cannot happen, and there are consequences if it ever does happen.

[Mr Kevan Jones (North Durham) (Lab)]

I do not question the Minister’s commitment to mental health. He is a great champion of parity of esteem, but he is part of a Government who are cutting money for mental health services. For young people in 2015 to be put in police cells is totally unacceptable. To pick up the point made by the right hon. Member for Sutton and Cheam (Paul Burstow) about CAMHS, is it not time not only for a fundamental review but for a new system, including the abolition of the present CAMHS system?

[Norman Lamb]

I am grateful to the hon. Gentleman for his generous remarks—perhaps he ought to talk to his Front-Bench colleagues about my commitment. He is absolutely right to highlight the fact that although there is quite a mixed picture across the country, in many areas there has been disinvestment in children’s mental health services. They are local decisions, and they are not decisions that I accept. That is why I made the serious point about the absolute importance of introducing waiting time and access standards, including in children’s mental health services. We need data so that we can monitor performance against those standards, and we need a payments system that does not disadvantage mental health. I also share his view that we need to change the way services are organised and commissioned so that we focus much more on prevention.

[Dr Julian Lewis (New Forest East) (Con)]

Does the Minister accept that this is a matter not only of funding but of philosophy? Does he agree that part of the problem is that certain primary care trusts have adopted a philosophy of cutting in-patient beds generally? For example, adult beds have been cut by 35% in areas as far apart as my constituency and that of my hon. Friend the Member for Burton (Andrew Griffiths). Does he detect any rowing back from that rather extreme philosophy in the near future?

[Norman Lamb]

We want to try to ensure that when there is a crisis, a bed is available locally. With regard to the philosophy of seeking to reduce the tendency to have long periods of in-patient care—institutionalising people—it is absolutely right that we move away from that and focus far more on early intervention, community support and recovery. That is the general trend in progressive views within mental health. However, there must be a bed available when a crisis occurs.

[Mrs Madeleine Moon (Bridgend) (Lab)]

The Minister generously attended the launch of the report by the all-party group on suicide and self-harm prevention, which showed that one third of local authorities have no suicide prevention plan. Has he found any correlation between the lack of such a plan, poor CAMHS provision and a high incidence of suicide, particularly among young men?

[Norman Lamb]

May I first pay tribute to the hon. Lady for her inspiring work on suicide? Not many people in the House focus on issues that are talked about so seldom, so I pay tribute to her for the brilliant leadership she has shown. The all-party group’s report provides some really interesting and important questions of the sort that she has put to me today. These are questions that we need to ask. We have not yet established that link, but I think that it enables us to start asking local areas those questions. The Deputy Prime Minister has talked about the ambition of avoiding every suicide. We can improve services across the board by focusing much more on preventing conditions deteriorating to the point where someone becomes so desperate that they choose to take their own life.

[Mr Adrian Sanders (Torbay) (LD)]

I welcome the Government’s announcement of an extra £7 million, although I do not know whether it will be enough. I am very pleased, on behalf of constituents in Devon and Cornwall, that we have a new facility opening in Torquay—it is not yet fully open—and hope that the Minister can visit it. I also welcome the fact that he is reviewing the place of safety designation, although I question whether that actually requires legislation. The case that occurred in my constituency raised something that he has not yet mentioned: the problem that a person trying to find an appropriate place has no central register to look at. If we want a hotel room, we can go online and find a vacancy, but finding a vacancy in an appropriate setting seems to take an enormous amount of time.

[Norman Lamb]

The case in my hon. Friend’s constituency highlighted an incredibly important issue. The lessons that are being learned as a result of that incident will result in improved co-ordination and reducing the risk of that sort of thing happening. It was completely intolerable that that young girl ended up in a police cell for that length of time, and we should all be completely clear about that. The crisis care concordat makes the objective clear. We asked every area to sign up—and every area did so by December—to committing to implement the standards in the concordat, one of which is to end the practice of under-18s going into police cells. I think we need to go further and ban it in law.

[Mark Reckless (Rochester and Strood) (UKIP)]

It is just over a year since 35 mental health beds at Medway Maritime hospital were closed. As those closures and the associated changes in Kent were referred to the Health Secretary, will the Minister review whether the changes promised to community care, particularly for some degree of residential provision in Medway, have taken place? Is he satisfied with current provision?

[Norman Lamb]

I am happy to look into that for the hon. Gentleman. Indeed, he can come along to one of my Monday evening advice sessions and we can discuss it further. It is clearly important that the right provision is available in his area.

[Mark Pritchard (The Wrekin) (Con)]

I welcome the new funding announced by the Minister. Surely one way of reducing pressure on in-patient beds is to expand mental health assessments within youth custody facilities and expand treatment within those facilities. What co-ordination is there between his Department and the Ministry of Justice on that issue?

--- Later in debate ---

[Norman Lamb]

My hon. Friend raises an incredibly important point. There is a lot of co-ordination between the two Departments. Indeed, he may be aware of a new taskforce set up by the Deputy Prime Minister to co-ordinate Departments’ work on mental health. There is a plan to roll out the liaison and diversion service nationally by 2017. No other country in the world is doing this on such an industrial scale, in order to ensure that someone who turns up at a police station or a court with an identifiable mental health problem gets referred for treatment. That is really exciting.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

The Minister is right about this. In the 10 years for which I chaired the Education Committee, I knew that child mental health services were not as good as they could have been. We now have a crisis. In the past, we patched things together with a partnership among children’s services, the local authority, mental health services in hospitals, and GPs. That partnership has been broken, mainly by the reforms that the coalition Government have introduced in commissioning and the fragmentation of so much else. The earlier a child is diagnosed and treated with therapeutic help, the better. At the moment, that is not happening. This is not just about beds; it is also about early intervention.

[Norman Lamb]

I totally agree. However, I caution the Opposition about going around declaring a crisis every second day, because the picture is very varied around the country. I agree with the hon. Gentleman about any unacceptable things that are happening. He makes a very good point about co-ordinating services much better. Indeed, a central focus of the children’s mental health taskforce is to try to ensure that we get much better, co-ordinated commissioning of care.

[James Morris (Halesowen and Rowley Regis) (Con)]

In my capacity as chair of the all-party group on mental health, I recently visited the Elms centre in Dudley, which is providing an excellent CAMHS service for the people of the borough. It is important to recognise that there are very high-quality CAMHS services in certain areas of the country, although we accept that there is variability. Does the Minister agree that the challenge is not just about the order of magnitude of resources but about ensuring that commissioners are prioritising CAMHS at a local level so that they make the right decisions about the sort of provision that is required in their area?

[Norman Lamb]

I pay tribute to my hon. Friend for the work that he does on mental health. He is another champion of mental health in this House. I also pay tribute to the people in the service in Dudley that he mentioned. I have visited a fantastic children and young people’s mental health service in Accrington in Lancashire—one of the six pilots on using psychological therapies for people with severe and enduring mental ill-health. He makes a very good point. We need to celebrate great care where we find it, and also ensure that commissioners, in local authorities and in clinical commissioning groups, take this seriously. The trouble is that when there are no standards at all in mental health, it is very easy for people quietly to cut back, thinking that they can get away with it. That is why I want to ensure that people suffering mental ill-health have exactly the same right to access treatment as anyone else.

[Alison Seabeck (Plymouth, Moor View) (Lab)]

It was interesting to hear the Minister say that he has learned lessons from the incident in Torbay, because there was exactly the same incident over a year ago in my constituency. A young person who had committed a violent offence found themselves in a police cell for 36 hours. I spent the best part of the day working with officers involved with mental health from the local authority and the health service, desperately trying to find an appropriate place for that person’s particular behavioural issue. They had not got a list. We looked at a place in Somerset that had closed, probably thanks to the 6% cuts. Will the Minister help Members of the House by placing in the Library a list of where the beds are and what the specialisms are? It would be enormously helpful to us, and certainly to those working in that field.

[Norman Lamb]

I would be happy to provide as much information as possible—I have no need to keep anything secret and I would like to assist as much as I can. Again, I caution that children and young people turning up in police cells has been happening, quietly and unnoticed, for a very long time, but the truth is that the numbers are coming down. That is good, but I want it to stop altogether.

[Sarah Newton (Truro and Falmouth) (Con)]

The Minister has been supportive of my work to secure specialist adolescent mental health services in Cornwall. When he next comes to Cornwall, will he meet me and local commissioners to see how we can benefit from new money and plans that have been communicated today?

[Norman Lamb]

If the diary allows I am certainly up for that, and I pay tribute to the hon. Lady for the work she has done in her county in trying to improve children’s mental health services. We must do that across the country, and there are many examples of real and significant improvements.

[Diana Johnson (Kingston upon Hull North) (Lab)]

We are discussing young people, and Natalie Carmichael has e-mailed me. She is 17, lives in Hull and suffers from anorexia nervosa, yet she had to go to Manchester—more than two and a half hours away—to access 24-hour care. She states:

“The illness itself is distressing enough…but I feel it made it ten times more traumatic the fact that I was hundreds of miles away from home and I couldn’t reach to my family for comfort and support in the tough experience I was battling.”

What does the Minister say to Natalie?

[Norman Lamb]

I find it as intolerable as she does, and that is why we are investing to improve access to beds in the locality. Indeed, we identified the hon. Lady’s region as an area where there were shortages of beds for children and young people’s mental health, and we have taken action to increase that number.

[Mr Philip Hollobone (Kettering) (Con)]

Which is the best CAMHS service in the country, why can it do it when others cannot, and what is stopping its best practice from being copied?

[Norman Lamb]

My hon. Friend makes an important point, and there are many excellent mental health services, as the hon. Member for somewhere in Birmingham—[Interruption.]—for Halesowen and Rowley Regis (James Morris), said earlier. If some areas can do things well with the available resources, then other areas can too. It is also true that some areas have chosen to cut funding for children’s mental health, in my view inappropriately.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

Birmingham is one of the fastest growing younger cities in Europe—40% of its population is under 25, and 30% under 15. Combined with local authority cuts of £281 per head in the next financial year, and a totally dysfunctional commissioning system, does the Minister seriously think that even the good intentions of the children and young person’s taskforce will address the problems we already have, as well as those that we can see coming but have no means of remedying?

[Norman Lamb]

Again, I gently make the point that we all, on both sides of the House, have to recognise the need over the next five years to make better use of the resources available. The hon. Lady’s own party does not propose ring-fencing local authority funding for the provision of mental health services at the lower tier level. We all have to work on making more effective use of the money, and I genuinely think that the taskforce is an opportunity to modernise how we organise services, particularly commissioning—having four different commissioners does not create the best chance of co-ordinating services.

[David Rutley (Macclesfield) (Con)]

Like many in the House, I recognise the Minister’s commitment to this important issue. I speak to young people and teachers, and there is a growing recognition of the importance of mental health services for adolescent children. What research has the Minister undertaken to better understand the root courses of the mental health challenges facing young people today, particularly the impact of social media?

[Norman Lamb]

My hon. Friend is right to highlight an emerging and growing phenomenon causing increased distress for some young people. The prevalence survey, for which we now have the funding for 2015-16, is a massive opportunity to understand much better the scale of the problem we are seeking to deal with.

[Pat Glass (North West Durham) (Lab)]

In 2012, the Education Select Committee called CAMHS in this country a “national disgrace” and urged that the Department for Education and the Department of Health urgently get together to avoid the crisis we are seeing today. In the meantime, we have seen cuts in services, provision and funding, leading to the chaos today. I am incredibly unhappy with the complacency of the Minister’s answers. It is almost as if he is a spectator. He is the Minister with responsibility, and the answer is not a taskforce two years down the line or a prevalence survey five years down the line; it is to take action now.

--- Later in debate ---

[Norman Lamb]

I am left totally confused. The hon. Lady has just referred to my complacency, whereas the person who was just sitting next to her, the hon. Member for North Durham (Mr Jones), paid tribute to my passion in fighting for mental health services. So which is it?

If there was any substance to the hon. Lady’s question, it concerned the importance of mental health services and education working more effectively together and, as was said earlier, the role of schools. As a result of the taskforce, I think we can achieve much better collaboration among schools and mental health services. I also point out, as have hon. Members on her own side, that this is a long-standing problem that goes back far beyond 2010.

[Andy Sawford (Corby) (Lab/Co-op)]

The Minister might remember that I wrote to him about a local family who went through a living hell when a young girl was sent from East Northamptonshire to a hospital in Bury, where she was left for weeks; where there was conflicting advice about whether she should be there at all; and where the family felt she was getting worse not better. Will he look specifically at provision in Northamptonshire, particularly the provision of beds for teenagers, and reflect that, to be fair to CAMHS in Northamptonshire, ours is one of the worst-funded areas for health care in the whole country—way off the NHS England target?

[Norman Lamb]

I know that the hon. Gentleman is campaigning on this matter—he is right to do so—and I would be very happy to talk to him further about this case. The circumstances he describes are intolerable. As my hon. Friend the Member for Kettering (Mr Hollobone) said, the frustration is that, if some services and commissioners can avoid that, why does it happen in other areas of the country? However, I would be happy to discuss the matter with him.

Winterbourne View

Norman Lamb Excerpts

Thursday 29th January 2015 Written Statements

[The Minister of State, Department of Health (Norman Lamb)]

The Government’s review Transforming Care: A national response to “Winterbourne View Hospital: Department of Health Final Report (2012)” looked at why Winterbourne View happened and set out a programme of work to take every step we can, to ensure this does not happen again. The Government committed in Transforming Care to produce a report two years on to account for progress. This report is a collective account from partners across the health and care system to reflect the cross-system effort that has continued over the past year to tackle the root causes of the abuse and treatment of people at Winterbourne View.

The report sets out what has been done, providing an update in the annex of all the original actions in Transforming Care and what has been completed or is continuing. A significant number of the recommendations have been achieved. We now know how many people are in in-patient settings, where they are and who is responsible for them. NHS England has introduced care and treatment reviews for everyone in in-patient settings, with a multi-disciplinary team from health and social care, alongside experts by experience. One hundred and eighty one people are benefiting from £7 million DH capital funding to support people inappropriately placed in in-patient settings to move to more suitable housing. We have strengthened the accountability and corporate responsibility arrangements to assure the quality and safety of care services. A duty of candour which requires providers to inform service users where there are failings in care came into force for NHS providers last November, and will be extended to all other providers registered with the Care Quality Commission in this April. A fit and proper person’s test which requires providers to ensure that directors are fit to carry out their role came into force last November for NHS providers in NHS trusts, foundation trusts and special health authorities. All other providers will be required to comply by this April. The introduction of the forthcoming statutory offences of ill-treatment or wilful neglect will also send a clear message throughout the health and care system that intentionally poor care will never be tolerated. We have new guidance on minimising restrictive interventions and work is underway to improve data about the use of restraint. A more rigorous registration, assessment and inspection approach is in place for learning disability services. The Care Act 2014 enshrines new principles for adult social care including the principle of individual well-being which encompasses people having control of their day to day life, suitable accommodation and being able to contribute to society. The Act requires local authorities to consider people’s views, wishes and beliefs and focuses on the outcomes people themselves want to achieve. The Act also underpins and reinforces the importance of good quality, independent advocacy and will support people, their families and carers to raise concerns.

The report is also clear, however, that we have not made nearly enough progress to transform services. This cannot be tolerated. We recognise that there is still much more to do to reduce the need for in-patient care. There are many people with very complex needs, in many different types of in-patient settings and we need to ensure the right decisions are made about their care, listening to individuals, their families and carers. All partners involved in Transforming Care have agreed the need for a single programme to collectively drive forward the changes needed. A strengthened programme will be put in place, which takes into consideration the recommendations of Winterbourne View—A Time to for Change (2014) by Sir Stephen Bubb, and will drive a better co-ordinated approach to achieve faster and sustainable progress. The details of this approach can be accessed at: http://www.england.nhs.uk/ourwork/gual- clin- lead/ld/transform-care/.

Partnership working is essential. We are clear that this cannot all be done from Whitehall. There has to be a change in culture and behaviour in local areas. We understand that this is not easy which is why, building on learning from work over the past two years, we are determined to make a difference for people and their families in the decisions about admission and discharge from hospitals. We are looking to consult on a range of potential future measures to strengthen people’s rights in the health and care system. This is likely to include options for ensuring people’s individual well-being is at the heart of decisions in both health and social care, and issues around how the Mental Health Act is applied.

Copies of the Winterbourne View Two Years On report have been placed in the House Library. It can also be accessed at:

http://www.gov.uk/government/publications/Winterbourne-View-2-years-on.

[HCWS231]

National Health Service

Norman Lamb Excerpts

Wednesday 21st January 2015 Commons Chamber

[The Minister of State, Department of Health (Norman Lamb)]

My hon. Friend mentioned Professor Allyson Pollock. Is he aware that she particularly highlighted the extraordinary amount of money spent under the previous Government on the private finance initiative, mortgaging the future of the NHS to the tune of more than £80 billion? In the course of the next Parliament, that will cost more than £11 billion.

[David T. C. Davies]

I commend the professor’s book, and I hope Labour Members read it, as well as looking at the NHS comparators between England and Wales, which they obviously have not done so far. I would like Labour Members to tell us whether—if they ever are in government; I hope they will not be—they will guarantee to continue with the cancer drugs fund, which has allowed thousands of people in England to live longer and more productive lives than they otherwise would have.

The situation is not the same in Wales, where these cancer drugs are routinely denied to people. I am talking about people such as my constituent Ann Wilkinson, who is also trying to care for a very ill husband but who has been denied Avastin. She has had to find other means to get it, and other seriously ill people in Wales have had to move to England or find people’s spare rooms to sleep in.

We heard something about cuts, but the reality is that we have guaranteed the NHS budget in England while it has been cut by about 8% in Wales. Thousands of people are members of Action for our Health, a group comprising people campaigning in Wales to be treated in England. Some people say that the NHS is the envy of the world, and perhaps it is, but the NHS in England is very much the envy of Wales. To see that we need only ask the thousands of people—ordinary patients—in a campaign group who want to be treated by the NHS that is run by this coalition Government and not by the NHS that is run by Labour.

I wish to finish by saying to my right hon. Friend the Minister that I congratulate him on the better ambulance response times he is delivering in England than Labour is delivering in Wales; on the better accident and emergency turnaround times he is delivering in England than Labour is delivering in Wales; on the shorter waiting lists in England than people face in Wales; and on the cancer drugs fund, allowing people to live longer in England than they otherwise would in Wales. Most of all, I congratulate him on protecting that NHS budget—on standing up for the NHS instead of cutting the budget, as the Labour party has done in Wales. I very much hope that he is able to continue with that good work in years to come.

--- Later in debate ---

[The Minister of State, Department of Health (Norman Lamb)]

The NHS across the UK, including urgent and emergency care services, is facing enormous challenges. By the end of this Parliament, there will be nearly 1 million more over-65s than there were at its start, which means substantially more patients with more complex health needs, but such pressures are not unique to England. All hon. Members need to think very carefully about how we pursue the debate on the challenges and pressures that the NHS is facing. Patients and the NHS do not need or want cynicism and party point scoring. My right hon. Friend the Member for Chelmsford (Mr Burns) and my hon. Friend the Member for Cambridge (Dr Huppert) were absolutely correct to make that point.

[Sarah Newton]

Does my right hon. Friend agree that the pioneer programme in Cornwall is really leading the way, with the provisional results showing a 41% reduction in A and E and in-patient visits?

[Norman Lamb]

My hon. Friend makes a very good point. The Cornwall pioneer programme is doing the most amazing work making innovative change, involving Age UK alongside local doctors, and it is delivering real results.

Why does the Labour party make constant claims that the NHS in England is in crisis, when the position is so much worse in Wales, where Labour is in power?

[Ian Austin]

Will the Minister give way?

[Norman Lamb]

In a moment.

Why does the Labour party claim that the reforms are to blame when there has been no reform in Wales, yet the position there is worse? What people need and want is an open and honest debate about what should be done to secure the future of the NHS. The motion is about the pursuit of votes, not the interests of patients. If Labour Members—

[Several hon. Members]

rose—

[Norman Lamb]

Let me make this point.

If Labour Members are concerned about the interests of patients, why do they not agree to the suggestion by Professor Bruce Keogh, a respected clinician, for an investigation into safety in the Welsh NHS? Why do they remain silent?

[Andy Burnham]

The Minister accuses us of bringing politics into the NHS, but did not he and his colleagues put politics at its heart when they signed up to a Tory agenda to put market forces at the heart of the national health service?

[Norman Lamb]

That is absolute rubbish. Indeed, one of the right hon. Gentleman’s predecessors, the right hon. Member for Hull West and somewhere—

[Mr Speaker]

The right hon. Member for Kingston upon Hull West and Hessle, rather than “somewhere”.

[Norman Lamb]

I apologise, Mr Speaker. The right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) spoke very candidly about the role of the private sector under the previous Labour Government, which the shadow Secretary of State constantly seeks to deny.

[Ian Austin]

Will the Minister give way?

[Norman Lamb]

No. I need to make progress, and I have very little time.

In a Guardian debate yesterday, in which I took part, Peter Carter, the respected chief executive of the Royal College of Nursing, spoke of the need for political consensus

“so that we stop this ridiculous points-scoring”,

which

“frankly is destructive and does nothing to enhance the quality of the debate.”

Let us take his plea on board. I have argued for a non-partisan review of NHS and care budgets this year —whoever is in power—which would engage the public. We should all commit to that.

Labour claims that it will increase funding, but its proposed way of doing so appears to be unravelling before our eyes. Lord Mandelson has described the mansion tax as “sort of crude” and “sort of short-termist”. In the debate, the hon. Member for Hackney North and Stoke Newington (Ms Abbott) cast doubt on how much the policy would raise.

Before I address the main issues, I want to pick up the remarks made by the right hon. Member for Kingston upon Hull West and Hessle, who raised important issues about mental health. He talked about the case of his constituent, Beth. It is intolerable that she has been shunted around the country. I have met the right hon. Gentleman, and I am happy to engage with him again. It is unacceptable for this to continue to happen. That is why there is an urgent need for children’s mental health services to be reformed, and our taskforce will soon report on the essential changes that are necessary.

[Liz Kendall]

Will the Minister give way?

[Norman Lamb]

I do not have time.

I am pleased that the right hon. Member for Kingston upon Hull West and Hessle endorsed the case for access and waiting times standards in mental health, which I think will have the same transformative effect as they had in cancer care when his party was in government. As my hon. Friend the Member for Norwich North (Chloe Smith) said, why is mental health not in the motion? It certainly ought to be.

[Liz Kendall]

Will the Minister give way?

[Norman Lamb]

Let me make this point.

I acknowledge that several Members, including the hon. Members for Penistone and Stocksbridge (Angela Smith) and for Barrow and Furness (John Woodcock), raised distressing cases. I offer my personal sympathies to everyone who has been let down by the system. Such cases should motivate us all to strive to do everything that we can to improve how our NHS operates and to address the areas where it falls short.

The Opposition claim that the move from NHS Direct to NHS 111 has increased the demand faced by accident and emergency departments. There is no evidence to support that claim. Only 8% of calls result in a recommendation to go to A and E, and 30% of callers say that they would have gone to A and E if NHS 111 had not been available.

An accusation has been made about the impact of local authority cuts on social care. I remind the Labour party that the Government were faced with a £160 billion black hole in the public finances and had to act to sort that out. There is still no proposal from the Labour party to increase the funding for social care. The claims that it makes are hollow, without the money to go with them.

Let us look at one of the key indicators: delayed discharges from hospital. From August 2010 to November 2014, delayed days attributable solely to social care decreased from 38,324 to 37,000. The position is not as simple as some people suggest. Social care is performing incredibly well under difficult circumstances. In Cambridgeshire, there is the brilliant development of a service for older people to address their needs in innovative ways.

It has been claimed that the closure of walk-in centres has led to the current pressures on A and E. Again, we need to look at the evidence. A report by Monitor found that the reasons why local commissioners decided to close walk-in centres included that they were replacing them with urgent care centres co-located with A and E departments or other models of integrating primary care staff in A and E departments. The situation is not as simple as is suggested by the claim that walk-in centres have been closed and A and E has been left to pick up the burden.

The Opposition have said that the ambulance service is failing. In fact, ambulance services nationally are delivering nearly 2,000 more emergency journeys every day than in 2010. Ambulances respond to the majority of life-threatening cases in less than eight minutes. The Government have provided an additional £50 million to support ambulance services through this winter. It is right to take clinical advice to ensure that target response times are clinically based to avoid the unintended consequences of ambulance crews being driven crazy in the pursuit of targets, when it is patient safety that should be prioritised.

I come to the solution. In the short term, the Government have made an additional £700 million available to the NHS to cope with the pressures this winter. The right hon. Member for Tottenham (Mr Lammy) did at least acknowledge that. In the longer term, we need to focus on stopping the crises from occurring in the first place. We need a much greater focus on prevention, better integration of health and social care, and the implementation of Simon Stevens’s forward view.

I thank NHS staff for the amazing work that they do, often under great pressure, and the tremendous commitment that they make. We owe it to them and to the public to ensure that our NHS is protected and enhanced. Most people who use urgent and emergency care services receive effective, timely treatment. That is as it should be. Patients and their families should get the right advice and should get a response when they need it. We set the toughest standards in the world, and rightly so. We all know that those standards are under pressure across the UK, so let us be open and honest about that.

[Mr Alan Campbell (Tynemouth) (Lab)]

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

Question agreed to.

Main Question accordingly put.